scholarly journals Narrative Review of Neurologic Complications in Adults on ECMO: Prevalence, Risks, Outcomes, and Prevention Strategies

2021 ◽  
Vol 8 ◽  
Author(s):  
Hongling Zhang ◽  
Jiqian Xu ◽  
Xiaobo Yang ◽  
Xiaojing Zou ◽  
Huaqing Shu ◽  
...  
Keyword(s):  
Sharp Increase ◽  
Neurologic Complications ◽  
Prevention Strategies ◽  
Neurologic Injury ◽  
Life Saving ◽  
Important Approach ◽  
Venovenous Ecmo ◽  
Poor Outcomes ◽  
Monitoring Technologies ◽  
Current Monitoring

Extracorporeal membrane oxygenation (ECMO), a life-saving technique for patients with severe respiratory and cardiac diseases, is being increasingly utilized worldwide, particularly during the coronavirus disease 2019(COVID-19) pandemic, and there has been a sharp increase in the implementation of ECMO. However, due to the presence of various complications, the survival rate of patients undergoing ECMO remains low. Among the complications, the neurologic morbidity significantly associated with venoarterial and venovenous ECMO has received increasing attention. Generally, failure to recognize neurologic injury in time is reportedly associated with poor outcomes in patients on ECMO. Currently, multimodal monitoring is increasingly utilized in patients with devastating neurologic injuries and has been advocated as an important approach for early diagnosis. Here, we highlight the prevalence and outcomes, risk factors, current monitoring technologies, prevention, and treatment of neurologic complications in adult patients on ECMO. We believe that an improved understanding of neurologic complications presumably offers promising therapeutic solutions to prevent and treat neurologic morbidity.

scholarly journals World trauma education: hemorrhage control training for healthcare providers in India

2019 ◽  
Vol 4 (1) ◽  
pp. e000263 ◽  
Author(s):  
Lindsay Andrea Smith ◽  
Sarah Caughey ◽  
Susan Liu ◽  
Cassandra Villegas ◽  
Mohan Kilaru ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Trauma Patients ◽  
Bleeding Control ◽  
Cross Sectional Survey ◽  
Hemorrhage Control ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Life Saving ◽  
Poor Outcomes ◽  
Trauma Education

BackgroundHemorrhage remains a major cause of death around the world. Eighty percent of trauma patients in India do not receive medical care within the first hour. The etiology of these poor outcomes is multifactorial. We describe findings from the first Stop the Bleed (StB) course recently offered to a group of medical providers in southern India.MethodsA cross-sectional survey of 101 participants who attended StB trainings in India was performed. Pre-training and post-training questionnaires were collected from each participant. In total, 88 healthcare providers’ responses were analyzed. Three bleeding control skills were presented: wound compression, wound packing, and tourniquet application.ResultsAmong participants, only 23.9% had received prior bleeding control training. Participants who reported feeling ‘extremely confident’ responding to an emergency medical situation rose from 68.2% prior to StB training to 94.3% post-training. Regarding hemorrhage control abilities, 37.5% felt extremely confident before the training, compared with 95.5% after the training. For wound packing and tourniquet application, 44.3% and 53.4%, respectively, felt extremely confident pre-training, followed by 97.7% for both skills post-training. Importantly, 90.9% of StB trainees felt comfortable teaching newly acquired hemorrhage control skills. A significant majority of participants said that confidence in their wound packing and tourniquet skills would improve with more realistic mannequins.ConclusionTo our knowledge, this is the first StB training in India. Disparities in access to care, long transport times, and insufficient numbers of prehospital personnel contribute to its significant trauma burden. Dissemination of these critical life-saving skills into this region and the resulting civilian interventions will increase the number of trauma patients who survive long enough to reach a trauma center. Additionally, considerations should be given to translating the course into local languages to increase program reach.Level of EvidenceLevel IV.

scholarly journals Compulsory Licenses for Cancer Drugs: Does Circumventing Patent Rights Improve Access to Oncology Medications?

2016 ◽  
Vol 2 (5) ◽  
pp. 292-301 ◽  
Author(s):  
Cinthia Leite Frizzera Borges Bognar ◽  
Brittany L. Bychkovsky ◽  
Gilberto de Lima Lopes
Keyword(s):  
Cancer Control ◽  
Compulsory License ◽  
Legal Framework ◽  
Essential Medicines ◽  
Cancer Drugs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Life Saving ◽  
Poor Outcomes ◽  
Improve Access

Worldwide, there are enormous inequities in cancer control that cause poor outcomes among patients with cancer who live in low- and middle-income countries (LMICs). One of the biggest challenges that oncology faces today is how to increase patient access to expensive, but life-saving, therapies in LMICs. Access to cancer medications in LMICs is a major problem, especially in recent years, as the costs of these therapies continue to rise exponentially. One mechanism available to LMICs to improve access to cancer medications allows a country to pursue a compulsory license for a given drug. Here, we will review how the legal framework in the World Trade Organization's Trade-Related Aspects of Intellectual Property Rights Agreement and the Doha Declaration supports countries to circumvent patent laws and acquire compulsory licenses for essential medicines. We will also discuss the current and future role of compulsory licenses in oncology and how compulsory licenses may improve access to cancer drugs in LMICs.

Neurologic Complications of Cancer

2017 ◽  
Author(s):  
Soma Sengupta ◽  
Eudocia Q Lee ◽  
Patrick Y Wen
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Key Words ◽  
Early Recognition ◽  
Paraneoplastic Syndromes ◽  
Neurologic Complications ◽  
Neurologic Injury ◽  
Key Words Cancer ◽  
Mortality And Morbidity ◽  
Central Nervous System Metastases

Neurologic complications from cancer and its therapies can significantly impact mortality and morbidity. Early recognition and intervention are key to preventing permanent neurologic injury. This review discusses common and uncommon neurologic complications of cancer, including central nervous system metastases, treatment-related neurotoxicities (including immunotherapies), and paraneoplastic syndromes. Workup and management of these neurologic complications are also addressed. Key words: cancer, chemotherapy, metastases, nervous system complications, paraneoplastic syndromes

Neurologic Complications of Cancer

2017 ◽  
Author(s):  
Soma Sengupta ◽  
Eudocia Q Lee ◽  
Patrick Y Wen
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Key Words ◽  
Early Recognition ◽  
Paraneoplastic Syndromes ◽  
Neurologic Complications ◽  
Neurologic Injury ◽  
Key Words Cancer ◽  
Mortality And Morbidity ◽  
Central Nervous System Metastases

Neurologic complications from cancer and its therapies can significantly impact mortality and morbidity. Early recognition and intervention are key to preventing permanent neurologic injury. This review discusses common and uncommon neurologic complications of cancer, including central nervous system metastases, treatment-related neurotoxicities (including immunotherapies), and paraneoplastic syndromes. Workup and management of these neurologic complications are also addressed. Key words: cancer, chemotherapy, metastases, nervous system complications, paraneoplastic syndromes

Serious Complications Related to Regional Anesthesia

1997 ◽  
Vol 87 (3) ◽  
pp. 479-486 ◽  
Author(s):  
Yves Auroy ◽  
Patrick Narchi ◽  
Antoine Messiah ◽  
Lawrence Litt ◽  
Bernard Rouvier ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spinal Anesthesia ◽  
Regional Anesthesia ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Neurologic Complications ◽  
Needle Placement ◽  
Neurologic Injury ◽  
Pain On Injection ◽  
Neurologic Deficits

Background Serious complications related to regional anesthesia have previously been described primarily in case reports and retrospective surveys. The authors prospectively evaluated a multicenter series of regional anesthetics, using preplanned criteria to measure the incidence and characteristics of associated serious complications. Methods Requests were sent to 4,927 French anesthesiologists in advance of a subsequent 5-month study period. Participating anesthesiologists were asked for detailed reports of serious complications occurring during or after regional anesthetics performed by them during the study interval. Details regarding each complication then were obtained via a second questionnaire. Results The number of responding anesthesiolgists was 736. The number of regional anesthetics performed was 103,730, corresponding to 40,640 spinal anesthetics, 30,413 epidural anesthetics, 21,278 peripheral nerve blocks, and 11,229 intravenous regional anesthetics. Reports of 98 severe complications were received, with follow-up information being obtained for 97. In 89 cases, complications were attributed fully or partially to regional anesthesia. Thirty-two cardiac arrests, seven of which were fatal, occurred during the study. Of these, 26 occurred during spinal anesthesia, with 6 being fatal, 3 occurred during epidural anesthesia, and 3 more occurred during peripheral blocks. The higher incidence of cardiac arrest during spinal anesthesia (6.4 +/- 1.2 per 10,000 patients) compared with all other regional anesthesia (1.0 +/- 0.4 per 10,000 patients) was statistically significant (P < 0.05). Of 34 neurologic complications (radiculopathy, cauda equina syndrome, paraplegia), 21 were associated either with paresthesia during puncture (n = 19) or with pain during injection (n = 2), suggesting nerve trauma or intraneural injection. Twelve patients who had neurologic complications after spinal anesthetics had no paresthesia during needle placement and no pain on injection. Of these 12 patients (7 with radiculopathy and 5 with cauda equina syndrome), 9 received intrathecal hyperbaric lidocaine, 5%. The incidence of neurologic injury was significantly greater after spinal anesthesia (6 +/- 1 per 10,000 cases; P < 0.05) than after each of the other types of regional procedures (1.6 +/- 0.5 per 10,000 cases for the weighted average). Seizures attributed to elevated serum levels of local anesthetics occurred in 23 patients, but none suffered a cardiac arrest. Conclusions (1) The incidence of cardiac arrest and neurologic injury related to regional anesthesia were very low, but both were more than three SDs greater after spinal anesthesia than after other regional procedures. (2) Two thirds of the patients with neurologic deficits had either a paresthesia during needle placement or pain on injection. (3) Seventy-five percent of the neurologic deficits after nontraumatic spinal anesthesia occurred in patients who had received hyperbaric lidocaine, 5%.

scholarly journals Perspectives on railway axle bearing condition monitoring

2019 ◽  
Vol 234 (1) ◽  
pp. 17-31 ◽  
Author(s):  
Mani Entezami ◽  
Clive Roberts ◽  
Paul Weston ◽  
Edward Stewart ◽  
Arash Amini ◽  
...  
Keyword(s):  
Condition Monitoring ◽  
Early Stage ◽  
Research Work ◽  
Railway Axle ◽  
Bearing Defects ◽  
Bearing Condition Monitoring ◽  
Condition Monitoring Systems ◽  
Monitoring Technologies ◽  
Signal Processing Methods ◽  
Current Monitoring

Defects in railway axle bearings can affect operational efficiency, or cause in-service failures, damaging the track and train. Healthy bearings produce a certain level of vibration and noise, but a bearing with a defect causes substantial changes in the vibration and noise levels. It is possible to detect the bearing defects at an early stage of their development, allowing an operator to repair the damage before it becomes serious. When a vehicle is scheduled for maintenance, or due for overhaul, knowledge of bearing damage and severity is beneficial, resulting in fewer operational problems and optimised fleet availability. This paper is a review of the state of the art in condition monitoring systems for rolling element bearings, especially the axlebox bearings. This includes exploring the sensing technologies, summarising the main signal processing methods and condition monitoring techniques, i.e. wayside and on-board. Examples of commercially available systems and outputs of current research work are presented. The effectiveness of the current monitoring technologies is assessed and the p– f curve is presented. It is concluded that the research and practical tests on axlebox bearing monitoring are limited compared to the generic bearing applications.

scholarly journals Successful Extracorporeal Membrane Oxygenation (ECMO) Use without Systemic Anticoagulation for Acute Respiratory Distress Syndrome in a Patient with Aneurysmal Subarachnoid Hemorrhage

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Amanda L. Faulkner ◽  
James David Bacon ◽  
Brian A. Fischer ◽  
Stephen L. Grupke ◽  
Kevin W. Hatton
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Subarachnoid Hemorrhage ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Hemorrhagic Stroke ◽  
Distress Syndrome ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Life Saving ◽  
Venovenous Ecmo

Extracorporeal membrane oxygenation (ECMO) is an important life-saving technology for patients with severe acute respiratory distress syndrome (ARDS). Unfortunately, ECMO has been traditionally contraindicated in patients with hemorrhagic neurologic diseases. The recent improvement in ECMO devices, increased utilization and experience with venovenous ECMO technologies among healthcare teams, and the use of ECMO without anticoagulation has expanded the potential populations that may benefit from ECMO. We present a case of successful utilization of venovenous ECMO for severe respiratory failure secondary to ARDS in a patient with aneurysmal subarachnoid hemorrhage and severe, episodic cerebral vasospasm. We also discuss important limitations and considerations for future successful use of ECMO in hemorrhagic stroke. This case report highlights the potential for this life-saving technology in patients with hemorrhagic stroke.

scholarly journals Numerical Study on the Dynamic Behavior of a Francis Turbine Runner Model with a Crack

2018 ◽  
Author(s):  
Ming Zhang ◽  
Xingfang Zhang ◽  
Weiqiang Zhao
Keyword(s):  
Dynamic Behavior ◽  
Numerical Study ◽  
Forced Response ◽  
Francis Turbine ◽  
Vibration Localization ◽  
Localization Theory ◽  
Turbine Runner ◽  
Intersection Line ◽  
Monitoring Technologies ◽  
Current Monitoring

The crack in the blade is the most common type of fatigue damage for Francis turbines. However, the crack sometimes is difficult to be detected in time using the current monitoring system even when the crack is very large. To better monitor the crack, it is imperative to research the effect of a crack on the dynamic behavior of a Francis turbine. In this paper, the dynamic behavior of a Francis turbine runner model with a crack was researched numerically. The intact numerical model was first validated by the experimental data available. Then, a crack was created at the intersection line between one blade and the crown. The change in dynamic behavior with increasing crack length was investigated. Crack-induced vibration localization theory was used to explain the dynamic behavior changes due to the crack. Modal analysis showed that the adopted theory could basically explain the modal behavior change due to the crack. The FFT results of the modal shapes and the localization factors (LF) were used to explain the forced response changes due to the crack. Based on the above analysis, the challenge of crack monitoring was analyzed. This research can also provide some references for more advanced monitoring technologies.

scholarly journals Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

2009 ◽  
Vol 26 (6) ◽  
pp. E9 ◽  
Author(s):  
M. Reid Gooch ◽  
Greg E. Gin ◽  
Tyler J. Kenning ◽  
John W. German
Keyword(s):  
Decompressive Craniectomy ◽  
Complication Rate ◽  
Demographic Data ◽  
Retrospective Chart Review ◽  
Intraoperative Hypotension ◽  
Wound Breakdown ◽  
Life Saving ◽  
Increased Risk ◽  
Poor Outcomes ◽  
Second Procedure

Object Decompressive craniectomy is a potentially life-saving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or cerebral infarction. Once performed, surviving patients are obligated to undergo a second procedure for cranial reconstruction. The complications following cranial reconstruction are not well described in the literature and may very well be underreported. A review of the complications would suggest measures to improve the care of these patients. Methods A retrospective chart review was undertaken of all patients who had undergone cranioplasty during a 7-year period. Demographic data, indications for craniectomy, as well as preoperative, intraoperative, and postoperative parameters following cranioplasty, were recorded. Perioperative and postoperative complications were also recorded. Patients were classified as having no complications, any complications, and complications requiring reoperation. The groups were compared to identify risk factors predictive of poor outcomes. Results The authors identified 62 patients who had undergone cranioplasty. The immediate postoperative complication rate was 34%. Of these, 46 patients did not require reoperation and 16 did. Of those requiring reoperation, 7 were due to infection, 2 from wound breakdown, 2 from intracranial hemorrhage, 3 from bone resorption, and 1 from a sunken cranioplasty, and 1 patient's cranioplasty procedure was prematurely ended due to intraoperative hypotension and bradycardia. The only factor statistically associated with need for reoperation was the presence of a bifrontal cranial defect (bifrontal: 8 [67%] of 12, requiring reoperation; unilateral: 8 [16%] of 49 requiring reoperation; p < 0.01) Conclusions Cranioplasty following decompressive craniectomy is associated with a high complication rate. Patients undergoing a bifrontal craniectomy are at significantly increased risk for postcranioplasty complications, including the need for reoperation.

Research on Stray Current Monitoring of Subway Tracks

2012 ◽  
Vol 490-495 ◽  
pp. 2494-2498 ◽  
Author(s):  
Dong Liang Zhang ◽  
Yun Lin Yang
Keyword(s):  
Stray Current ◽  
Advantages And Disadvantages ◽  
Detection Technology ◽  
Monitoring Technologies ◽  
Current Monitoring

This paper analyzes the cause of stray current of subway tracks, classifies the stray current, and explains the hazards. Based on this, the paper also summarizes the advantages and disadvantages of traditional monitoring technologies and current monitoring technologies, and applies the current CIPS detection technology to make simulation in the laboratory. The simulation result well reflects the distribution of stray current on the rail.

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