Early Rescue Research Articles

Surfactant, mechanical ventilation or CPAP for treatment of early respiratory failure in preterm infants: A continuing conundrum?

s2view.con/pas/view.php?nu=PAS10L1660. Accessed on January 25, 2010. 4. Sandri F, Plavka R, Simeoni U; CURPAP Advisory Board. The CURPAP study: an international randomized controlled trial to evaluate the efficacy of combining prophylactic surfactant and early nasal continuous positive airway pressure in very preterm infants. Neonatology. 2008;94:60-2. 5. Tsakalidis C, Kourti M, Karayianni P, Rallis D, Porpodi M, Nikolaidis N. Early rescue administration of surfactant and nasal continuous positive airway pressure in preterm infants <32 weeks gestation. Indian Pediatr. 2011;48:601-5.

Candidiasis invasora en un receptor de trasplante hepático: tratamiento antifúngico de rescate precoz

Background : Some liver transplant recipients could be at risk for candidemia or invasive candidiasis during the immediate postoperative period after transplantation. Prophylaxis is the best strategy to reduce the incidence of invasive fungal infection caused by Candida species in high-risk liver transplant recipients (HR-LTR), but in cases of suspected breakthrough invasive fungal infection due to Candida, both a rapid diagnosis process and early antifungal treatment are the most important factors impacting on the prognosis. Clinical case We report a case of early rescue treatment with anidulafungin in a HR-LTR with complicated postoperative course. We discuss risk factors, prophylaxis, sensitivity of biomarkers, and characteristics of antifungal management. Conclusions : Early rescue antifungal treatment using candins improves the prognosis in HR-LTR suffering from invasive candidiasis.

Analysis of rescue and drowning history from a lifeguarded waterpark environment

The objective of this paper is to analyse rescue history from a lifeguarded waterpark environment using four characteristics: gender, age, water depth and type of aquatic attraction together with the actions taken by the guard to minimise the time needed to restore respiration in the case of loss of spontaneous respiration (LSR). Analysis of 63,800,000 guests with 56,000 rescues and 32 LSR rescues shows that children and shallow water both had relatively high levels of rescues [62.6% for children aged 1–12 years and 42% for water depth less than 1.52 m (5 ft)] and LSR rescues [53.2% for children aged 1–12 years and 65.6% for water depth less than 1.52 m (5 ft.)] with 87.5% of the LSR rescues resuming spontaneous respiration and 75% having a poolside neurological rating of Alert. Recommendations aremade to train lifeguards in effective scanning and early victim recognition and rescue together with the use of in-water intervention in rescue protocols.

Rescue ICSI: Choose the Optimal Rescue Window before Oocyte Aging

Objective To evaluate the application value of rescue ICSI in fertilization failure after conventional IVF and choose the best rescue window before oocyte aging according to the results of rescue ICSI performed in different time. Methods The data of 93 IVF cycles were analyzed retrospectively. Rescue ICSI was performed in these cycles after conventional IVF failure. Because of the different rescue time, these cycles were divided into two groups: early rescue group (group A, 77 cycles, rescue ICSI performed 4–8 h after conventional IVF) and late rescue group (group B, 16 cycles, rescue ICSI performed 20–22 h after conventional IVF). Results There were no statistically significant differences in age of female, duration of infertility, number of oocytes retrieved every cycle. The normal fertilization rate, pregnancy rate and implantation rate were decreased in group B compared with those in group A (P Conclusion Rescue ICSI is effective if fertilization was failure after conventional IVF, the most important thing is to choose the reasonable rescue window before oocyte aging when ICSI is performed.

The effect of caudal vs intravenous morphine on early extubation and postoperative analgesic requirements for stage 2 and 3 single‐ventricle palliation: a double blind randomized trial

High-dose single-shot caudal morphine has been postulated to facilitate early extubation and to lower initial analgesic requirements after staged single-ventricle (SV) palliation. With Institutional Review Board approval and written informed parental consent, 64 SV children aged 75-1667 days were randomized to pre-incisional caudal morphine-bupivacaine (100 μg·kg(-1) morphine (concentration 0.1%), mixed with 0.25% bupivacaine with 1 : 200,000 epinephrine, total 1 ml·kg(-1)) and postcardiopulmonary bypass (CPB) intravenous (IV) droperidol (75 μg·kg(-1)) ('active caudal group') or pre-incisional caudal saline (1 ml·kg(-1)) and post-CPB IV morphine (150 μg·kg(-1)) with droperidol (75 μg·kg(-1)) ('active IV group'). Assignment remained concealed from families and the care teams throughout the trial. Early extubation failure rates (primary or reintubation within 24 h), time to first postoperative rescue morphine analgesia, and 12-h postoperative morphine requirements were assessed for extubated patients. Thirty-one (12 stage 2) SV patients received caudal morphine and 32 (15 stage 2) received IV morphine. Extubation failure rates were 6/31 (19%) for caudal and 5/32 (16%) for IV morphine. For successfully extubated patients (n = 54), active caudal treatment significantly delayed the need for postoperative rescue morphine in stage 3 patients (P = 0.02) but not in stage 2 patients (P = 0.189) (Kaplan-Meier survival analysis with LogRank test). The reduction in 12-h postoperative morphine requirements with active caudal treatment did not reach significance (P = 0.085) but morphine requirements were significantly higher for stage 2 compared with stage 3 patients (P < 0.001) (two-way anova in n = 50 extubated patients). High-dose caudal morphine with bupivacaine delayed the need for rescue morphine analgesia in stage 3 patients. All stage 2 patients required early rescue morphine and had significantly higher postoperative 12-h morphine requirements than stage 3 patients. Early extubation is feasible for the majority of stage 2 and 3 SV patients regardless of analgesic regimen. The study was underpowered to assess differences in extubation failure rates.

Sichuan Earthquake and Emergency Relief Care for Children

An 8.0-magnitude earthquake struck Sichuan province of China on May 12, 2008. Over the next 10 days, the firstly arrived uniformed pediatricians in the epicenter zone took part in emergency relief care for children. The investigations of major injuries and diseases in children were taken. Demographic data collected included (if possible) age, date of presentation, injury, disease, and surgery performed. Total casualties were estimated to be more than 80,000, and much more were injured. Eight hundred eighty-two inpatients were treated by the relief team during the first 10 days. Of 882 inpatients, 192 (21.8%) were younger than 18 years. Children's ages were not evenly distributed. Twenty-seven patients were neonates, infants, and toddlers (14%), 105 were school-aged (55%), and were 60 adolescents (31%). The admitted children had 256 injuries. Limb (106 cases, 55.2%) and body surface (67 cases, 34.9%) were the majorly injured locations. One hundred twenty-seven cases (66.2%) had simple open injuries, and 106 (55.2% had fractures. The children's conditions were evaluated as mild (121 cases, 63.0%), moderate (56 cases, 29.7%), severe (8 cases, 4.2%), and fatal (7 cases, 3.7%). More than 20% of patients requiring hospitalization were children. School-aged children were heavily injured. The increase in infectious diseases followed on. The data show that there is an immediate need for orthopedic and general surgery skills, and pediatricians should play an important role in early rescue and subsequent control of infectious diseases in a huge earthquake hazard.

VDR deficiency affects alveolar bone and cementum apposition in mice

ObjectiveTo compare the mineralisation density (MD), morphology and histology of alveolar bone and cementum amongst VDR +/+, VDR −/−, and VDR −/− groups supplemented with a diet TD 96348, containing 20% lactose, 2.0% calcium and 1.25% phosphorous. MethodsFour groups of mice (6 mice/group) were identified by genotyping: VDR +/+ mice (VDR wild type), VDR −/− mice (VDR deficient), VDR −/− offsprings derived from VDR −/− parents receiving a supplemental diet (early rescued), and VDR −/− mice fed with a supplemental diet beginning at age one month (late rescued). All mice were sacrificed at age 70.5 days. Micro-CT was used to compare MD and morphology of alveolar bone and cementum. H–E and Toluidine blue staining was used to examine the ultrastructure of the alveolar bone and cementum at matched locations. ResultsIn VDR −/− group, alveolar bone and cementum failed to mineralise normally. Early rescue increased MD of alveolar bone in VDR −/− mice with excessive alveolar bone formation, but which not observed in late rescue group. MD and morphology of cementum–dentine complex in both early and late rescue groups were comparable with VDR +/+ group when feeding with high-calcium rescue diet. ConclusionsVDR affects alveolar bone mineralisation and formation systemically and locally. However, cementum apposition and mineralisation is mainly regulated by calcium concentrations in serum.

Rescuing neurons in prion disease

One of the major current challenges to both medicine and neuroscience is the treatment of neurodegenerative diseases, which pose an ever-increasing medical, social and economic burden in the developed world. These disorders, which include Alzheimer's, Huntington's and Parkinson's diseases, and the rarer prion diseases, are separate entities clinically but have common features, including aggregates of misfolded proteins and varying patterns of neurodegeneration. A key barrier to effective treatment is that patients present clinically with advanced, irreversible, neuronal loss. Critically, mechanisms of neurotoxicity are poorly understood. Prevention of neuronal loss, ideally by targeting underlying pathogenic mechanisms, must be the aim of therapy. The present review describes the rationale and experimental approaches that have allowed such prevention, rescuing neurons in mice with prion disease. This rescue cured animals of a rapidly fatal neurodegenerative condition, resulting in symptom-free survival for their natural lifespan. Early pathological changes were reversed; behavioural, cognitive and neurophysiological deficits were recovered; and there was no neuronal loss. This was achieved by targeting the central pathogenic process in prion disease rather than the presumed toxic species, first by proof-of-principle experiments in transgenic mice and then by treatment using RNA interference for gene knockdown. The results have been a new therapeutic target for prion disease, further insight into mechanisms of prion neurotoxicity and the discovery of a window of reversibility in neuronal damage. Furthermore, the work gives rise to new concepts for treatment strategies for other neurodegenerative disorders, and highlights the need for clinical detection of early neuronal dysfunction, so that similar early rescue can also be achieved for these disorders.

Early rescue administration of surfactant and nasal continuous positive airway pressure in preterm infants &lt;32 weeks gestation

This study reports our institutional experience on the outcome after prophylactic and early rescue endotracheal instillation of surfactant within 20 minutes of birth, followed by extubation and nasal continuous positive airway pressure (NCPAP) in preterm infants <32 weeks gestational age. A total of 142 infants were prospectively studied (42, gestational age from 23 to 27 and 100, from 28 up to 32 weeks). All infants were electively intubated for administration of 200 mg/kg porcine isolated surfactant (Curosurf, Chiesi Farmaceutici SPA, Parma, Italy) as soon as practicably possible (within 20 min after birth) and NCPAP was then initiated. Extubation and switch to NCPAP at 6 h was successful in 6/42 (14.3%) infants less than 28 weeks gestational age and 75/100 (75%) infants 28-32 weeks gestational age. Out of 81 infants that were successfully extubated, 76 (93.83%) never required re-ventilation. At 96 h of age, need for continuing intubation and ventilation was required by 6/38 (15.8%) alive infants <28 weeks gestational age and 8/100 (8%) infants 28-32 weeks gestational age. Mean duration of NCPAP post-extubation was 38±20 hours for infants 23-27 wks and 29±15 hours for infants 28-32 wks gestational age. The mortality rate was 2.81% (4/142). Implementation of prophylactic or early rescue administration of surfactant with NCPAP in infants at high risk for developing RDS in neonatal ICU is a safe modality of respiratory support in preterm infants.

Superior glottic views with the GlideScope® and Airtraq® laryngoscopes compared with an anterior commissure laryngoscope

To the Editor, In the unanticipated difficult airway, an anesthesiologist or otolaryngologist may perform direct laryngoscopy with a rigid anterior commissure laryngoscope. There have been case reports of using the anterior commissure laryngoscope for laryngoscopic rescue in difficult airways. We describe a case in which the view we obtained using two different video laryngoscopes was improved over that seen by an experienced otolaryngologist using an anterior commissure laryngoscope and over that seen by an anesthesiologist using a direct laryngoscope. This observation provides anecdotal support for the role of video laryngoscopy as an early rescue device when direct laryngoscopy affords an inadequate laryngeal view. This report is presented with the written consent of the patient. A 41-yr-old man presented with a recurrence of a squamous cell carcinoma of the tongue. On this occasion, we planned a diagnostic panendoscopy tracheostomy, bilateral neck dissection, composite mandibular resection, and reconstruction. Twelve months earlier, the patient had undergone a panendoscopy, bilateral neck dissection, mandibulotomy, partial glossectomy, and a free forearm flap to the floor of the mouth. Seven months later, a recurrence prompted cisplatin chemotherapy and irradiation with 70 Gy delivered in 35 fractions over seven weeks. The anesthesia chart from the first operation revealed no problems with bag-mask ventilation; direct laryngoscopy offered a Cormack-Lehane (C/L) grade 1 laryngeal view. The patient’s airway assessment prior to the second operation revealed an obvious flap reconstruction of the right tongue, modified Mallampati 2 view, mouth opening greater than three finger breadths, and normal neck flexion with slightly restricted extension. He had full dentition and a prominent overbite but could just approximate his maxillary and mandibular incisors. His anterior neck was swollen and firm to the touch. His body mass index was 21 kg m, and he denied any gastro-esophageal reflux. We felt that direct laryngoscopy would be difficult, but not bag-mask ventilation. Anesthesia was induced with midazolam 2 mg, remifentanil 40 lg, propofol 150 mg, and succinylcholine 100 mg iv. Following induction of anesthesia bag-mask, ventilation was easily achieved. The staff otolaryngologist inserted the anterior commissure laryngoscope as part of the panendoscopy. Since this was achieved with some difficulty, the surgeon introduced an Eschmann Tracheal Tube Introducer (Smiths Medical International Ltd, Hythe, Kent, UK) into the patient’s trachea over which an 8-mm (internal diameter) endotracheal tube was advanced. The best laryngeal view obtained with the anterior commissure laryngoscope, by using external laryngeal pressure and considerable force, was a C/L 2-B. Once a tracheostomy had been performed, three different laryngoscopes were compared by one of the authors (S.K.). Direct laryngoscopy using a Macintosh #3 provided a C/L 3 view. The Airtraq Optical Laryngoscope (Prodol Meditec, Viscaya, Spain) and the GlideScope Cobalt Advanced Video Laryngoscope (AVL) (Verathon Medical, Bothell, WA, USA), both indirect laryngoscopes, provided better views compared with the previous two laryngoscopes. No Electronic supplementary material The online version of this article (doi:10.1007/s12630-010-9413-2) contains supplementary material, which is available to authorized users.

Early Diagnosis and Rescue Pericardiocentesis for Acute Cardiac Tamponade during Radiofrequency Ablation for Arrhythmias. Is Fluoroscopy Enough?

With the number of complex catheter ablation procedures increasing, procedure-related acute cardiac tamponade is encountered more frequently in the cardiac catheterization laboratory. Survival depends on prompt recognition and rescue pericardiocentesis. The aim of this report was to validate fluoroscopic heart silhouette characteristics associated with cardiac tamponade as a diagnostic method, and evaluate the safety and effectiveness of fluoroscopy-guided pericardiocentesis during catheter ablation. All cases of acute cardiac tamponade that occurred in the cardiac catheterization laboratory during radiofrequency catheter ablation from March 2004 to November 2009 were reviewed retrospectively. Of 1,832 catheter ablation procedures performed during a 5-year period, 10 (0.55%) were complicated by cardiac tamponade. Fluoroscopic examination confirmed the diagnosis in all 10 patients and demonstrated effusions before hypotension in four patients. All patients were stabilized by fluoroscopy-guided pericardiocentesis with placement of an indwelling catheter and autologous transfusion. The time interval between recognition of cardiac tamponade and completion of pericardiocentesis was 6.0 ± 1.8 minutes (range 3-9 minutes). The mean aspirated blood volume was 437 mL (range 110-1,400 mL), and the mean autotransfused blood volume was 425 mL (range 100-1,384 mL). Surgical repair of the cardiac perforation was needed in one patient. No procedure-related death occurred. A reduction in the excursion of cardiac silhouette on fluoroscopy is an early diagnostic sign of cardiac tamponade during radiofrequency ablation. Fluoroscopy-guided pericardiocentesis is a safe and effective management strategy for cardiac tamponade developed in the cardiac catheterization laboratory.

E0567 Early diagnosis and rescue pericardiocentesis for acute cardiac tamponade during radiofrequency ablation for arrhythmias, Is fluoroscopy enough?

BackgroundWith the number of complex catheter ablation procedures increasing, procedure-related acute cardiac tamponade is encountered more frequently in the cardiac catheterisation laboratory. Survival depends on prompt recognisation and rescue pericardiocentesis.ObjectiveThe...

수중 작업에 있어서 극한 환경의 잠수 활동 기준 검토

This paper reviewed the diving standards for underwater work in hostile environment and analyzed applied Navy diving technique, diving equipments and procedure for rescue operation of Navy ship Cheonan`s missing crew occurred near Bak Ryung Do in March 2010. The operation was done beyond the international standards and safety practice, and by considering the nature of the mission, urgency and effectiveness as well as the detailed facts such as duration and depth of the dive, type of work to be performed, environmental conditions, time constraints of early rescue operation, it is analyzed that using air scuba diving system was adequate.

Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants

Early lung recruitment (ELR) during high-frequency oscillatory ventilation (HFOV) in combination with prophylactic surfactant use has been reported to reduce mortality, improve respiratory outcomes, and reduce the need for repeated surfactant dosing, suggesting that surfactant might be used more selectively in very low birth weight (VLBW) infants on HFOV than generally recommended. We report our first experience from such a selective early rescue use of surfactant in VLBW infants on HFOV. After a deliberate ELR maneuver and "optimal" continuous distending pressure (CDP) finding during HFOV, used as primary ventilation mode for VLBW infants with respiratory distress syndrome (RDS), surfactant was only given when an unsatisfactory oxygenation response to lung recruitment (as defined by CDP x FiO(2) > 5) was observed. Out of 144 VLBW infants on HFOV, 84 (58.3%) received surfactant and 60 (41.7%) did not. Duration of required oxygen supplementation (37.4 +/- 44.9 vs. 46.2 +/- 35.4 days; P = 0.031) and respiratory support (i.e., n-CPAP and/or mechanical ventilation; 22.3 +/- 19.3 vs. 38.2 +/- 24.3 days; P = 0.001) was shorter for infants who did not receive surfactant than for those who did. The incidence and severity of bronchopulmonary dysplasia was similar in both groups, and there was no difference in survival rates between groups. Subgroup analysis for infants of less than 28 weeks of gestation revealed similar results. First intention HFOV combined with an early attempt at lung volume optimization might allow surfactants to be used more selectively (in relation to disease severity) in VLBW infants presenting with RDS at birth without negatively influencing the outcome.

Cochrane review: Inhaled nitric oxide for respiratory failure in preterm infants

AbstractBackgroundInhaled nitric oxide (iNO) has been proven to be effective in term infants with hypoxic respiratory failure. The pathophysiology of respiratory failure, and the potential risks, differ substantially in preterm infants. Therefore, analysis of the efficacy and toxicities of iNO in infants born before 35 weeks is necessary.ObjectivesTo determine the effect of treatment with iNO on the rates of death, bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), or neurodevelopmental disability in preterm newborn infants (&lt; 35 weeks gestation) with respiratory disease.Search strategyStandard methods of the Cochrane Neonatal Review Group were used. MEDLINE, EMBASE, Healthstar and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) were searched, using the following keywords: nitric oxide, clinical trial, and newborn covering the years from 1985 to 2006. In addition, the abstracts of the Pediatric Academic Societies were also searched.Selection criteriaRandomised and quasi‐randomised studies in preterm infants with respiratory disease that compared the effects of administration of iNO gas compared to control, with or without placebo are included in this review.Data collection and analysisData regarding clinical outcomes including death, BPD (defined as oxygen dependence at 36 weeks postmenstrual age), IVH, periventricular leukomalacia (PVL), long term neurodevelopmental outcome and short term effects on oxygenation were excerpted from the trial reports by the investigators. Standard methods of the Cochrane Neonatal Review Group were used. Two investigators extracted, assessed and coded separately all data for each study. Any disagreement was resolved by discussion.Main resultsEleven randomised controlled trials of inhaled nitric oxide therapy in preterm infants were found. The trials have been grouped post hoc into three categories depending on the entry criteria; entry in the first three days of life based on oxygenation criteria (Kinsella 1999; Hascoet 2004; INNOVO 2005; Van Meurs 2004; Mercier 1999; Dani 2006), routine use in intubated preterm babies (Schreiber 2003; Kinsella 2006) and later enrolment based on an increased risk of BPD (Subhedar 1997; Ballard 2006). The usefulness of the overall analyses was considered limited by the differing characteristics of the studies, and only subgroup analyses were performed.Trials of early rescue treatment of infants based on oxygenation criteria demonstrated no significant effect of iNO on mortality or BPD. The subgroup of studies with routine use of iNO in intubated preterm infants demonstrated a marginally significant reduction in the combined outcome of death or BPD [typical RR 0.91 (95% CI 0.84, 0.99); typical RD ‐0.06 (95% CI ‐0.12, ‐0.01)]. Later treatment with iNO based on the risk of BPD demonstrated no significant benefit for this outcome in our analysis.Studies of early rescue treatment with iNO demonstrated a trend toward increased risk of severe IVH, whereas the subgroup of studies with routine use in intubated preterm infants seems to show a reduction in the risk of having either a severe IVH or PVL [typical RR 0.70 (95% CI 0.53, 0.91); typical RD ‐0.07 (95% CI ‐0.12, ‐0.02)].Later iNO treatment of infants at risk of BPD is given after the major risk period for IVH, and does not appear to lead to progression of old lesions.Two studies (Schreiber 2003; INNOVO 2005) presented data on long term neurodevelopmental outcome. The early routine treatment study (Schreiber 2003) showed an improved outcome at two years corrected age, while the rescue treatment study (INNOVO 2005) showed no effect of iNO.Authors' conclusionsiNO as rescue therapy for the very ill ventilated preterm infant does not appear to be effective and may increase the risk of severe IVH. Later use of iNO to prevent BPD also does not appear to be effective. Early routine use of iNO in mildly sick preterm infants may decrease serious brain injury and may improve survival without BPD. Further studies are needed to confirm these findings, to define groups most likely to benefit, and to describe long term outcomes.Plain Language SummaryInhaled nitric oxide for respiratory failure in preterm infantsThe use of inhaled nitric oxide (iNO) may help reduce breathing failure in preterm babies.Breathing failure in premature newborn babies may be complicated by raised pressure within the vessels that carry blood to the lung (pulmonary hypertension). Medications that cause sedation or muscle relaxation and mechanically assisted breathing (mechanical or assisted ventilation) are used to treat pulmonary hypertension. Nitric oxide is believed to help regulate muscle tone in the arteries of the lungs and, thereby lessen pulmonary hypertension; however, iNO may also cause excessive bleeding (haemorrhage). This review of studies found that nitric oxide therapy may improve the chances of the baby having an improved outcome, but only when used in babies who were mildly ill. These studies indicated that there may be a decrease in serious bleeding in the brain (intracranial hemorrhage). When given to babies who were very ill, iNO did not seem to help, and may have contributed to an increase in intracranial hemorrhage.

The causes and therapeutic of burn complicated by mental disorder

Objective To study the causes and therapeutic measures of burn complicated by mental disorder.Methods Recollected and analysed the related clinical data of the twenty-five patients with burn complicated by mental disorder since January 1998 to January 2008.Results All the patients had been well cured after comprehensive treatment.There is a significant higher proportion of mental disorder among aged patients,patients with extensive burn or delayed recovery.Conclusion Early prevention and rescue can significantly reduce the rate of burn complicated by mental disorder and synthetic therapeutic measures can increase the cure rate of patients. Key words: Burn; Mental disorder; Analysis of causes

Evaluation of early rescue ICSI by observation of the time events after conventional IVF

Evaluation of early rescue ICSI by observation of the time events after conventional IVF

Nursing on acute organophosphate poisoning patients' early mechanical ventilation rescue

Objecttive To discuss the experience of nursing on acute organophosphate poisoning patients' early mechanical ventilation rescue. Method Timely and thoroughly gastric lavage, early and full dosage use specific antidote and quickly achieved atropinization, early put to use mechanical ventilation, and strengthen observation and nursing. Result The data of blood gas analysis were obviously different in 32 patients before and after mechanical ventilation (P<0.05). Twenty-six patients were rescue successfully, and 6 patients were died. Success rate reached 81%. Conclusion Beside the systemic rescue, putting to use mechanical ventilation early and strengthening obser-vation and nursing is the key to the success of acute organophosphate poisoning patients' rescue. Key words: Early stage; Mechanical ventilation; Acute organophosphate poisoning; Nursing

Observe and nursing care of Delayed Rupture of the Spleen

Objective To investigate the methods of observe and nursing cage of Delayed Rupture of the Spleen.Methods The data of observe and nursing care of traumatic spleen rupture in our hospital from January 1997 to December 2007 was retrospectively analyzed.Results Among the 31 cages,27 received nonoperative treatment.And 27 by operation after the failure of nonoperative managemen due to the occurrence of delayed hemorrhage during the period of nonoperalive management after 2～4 days.4 received emergency operation.31 were cured.Conclusions It call increase the early diagnosis and rescue mission succeess rate when indication of consciousness,life physical sign,abdomenal physical sign,the methods of examine and diagnosis was constantly observed and the nursing care before operation and after operation was reinforced. Key words: Delayed; Spleen rupture; Observe; Nursing

Randomized controlled trial design in rheumatoid arthritis: the past decade.

Much progress has occurred over the past decade in rheumatoid arthritis trial design. Recognized challenges have led to the establishment of a clear regulatory pathway to demonstrate efficacy of a new therapeutic. The use of pure placebo beyond 12 to 16 weeks has been demonstrated to be unethical and thus background therapy and/or early rescue has become regular practice. Goals of remission and 'treating to targets' may prove more relevant to identify real-world use of new and existing therapeutics. Identification of rare adverse events associated with new therapies has resulted in intensive safety evaluation during randomized controlled trials and emphasis on postmarketing surveillance and use of registries.