Effective Precaution Research Articles

Salidroside pretreatment alleviates PM2.5 caused lung injury via inhibition of apoptosis and pyroptosis through regulating NLRP3 Inflammasome.

Ambient fine particulate matter (PM2.5) is considered a leading cause of pathogenic particulate matter induced lung injury. And Salidroside (Sal), the major bioactive constituent isolated from Rhodiola rosea L., has been shown to ameliorate lung injury in various conditions. To uncover the possible therapy for PM2.5 related pulmonary disease, we evaluated the protective role of Sal pre-treatment on PM2.5 induced lung injury in mice by utilizing the survival analysis, hematoxylin and eosin (H&E) staining, lung injury score, lung wet-to-dry weight ratio, enzyme-linked immunosorbent assay (ELISA) kits, immunoblot, immunofluorescence, and transmission electron microscopy (TEM). Impressively, our findings strongly indicated Sal as an effective precaution against PM2.5 induced lung injury. Pre-administration of Sal before PM2.5 treatment reduced the mortality within 120h and alleviated inflammatory responses by reducing the release of proinflammatory cytokines, including TNF-α, IL-1β, and IL-18. Meanwhile, Sal pretreatment blocked apoptosis and pyroptosis that introduced the tissue damage under PM2.5 treatment via regulating Bax/Bcl-2/caspase-3 and NF-κB/NLRP3/caspase-1 signal pathways. In summary, our research demonstrated that Sal could be a potential preventative therapy for PM2.5 caused lung injury by inhibiting the initiation and development of apoptosis and pyroptosis through down-regulating NLRP3 inflammasome pathway.

Estimation Failure Risk by 0.5-mm Differences in Autologous Hamstring Graft Diameter in Anterior Cruciate Ligament Reconstruction: A Meta-analysis

Background: Because grafts are made in 0.5-mm increments clinically for anterior cruciate ligament (ACL) reconstruction, it is important to clarify how the failure rate decreases as the diameter increases. Moreover, it is important to know whether even a slight increase in the graft diameter decreases the risk of failure. Hypothesis: The risk of failure decreases significantly with each 0.5-mm increase in hamstring graft diameter. Study Design: Meta-analysis; Level of evidence, 4. Methods: The systematic review and meta-analysis have estimated the diameter-specific failure risk for each 0.5-mm increase in ACL reconstruction using autologous hamstring grafts. We searched for studies describing the relationship between graft diameter and failure rate published before December 1, 2021, in leading databases, such as PubMed, EMBASE, Cochrane Library, and Web of Science, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies using single-bundle autologous hamstring grafts to investigate the relationship between failure rate and graft diameter of 0.5-mm intervals with >1-year follow-up. Then, we calculated the failure risk caused by 0.5-mm differences in autologous hamstring graft diameter. Assuming Poisson distribution for the statistical model, we employed an extended linear mixed-effects model in the meta-analyses. Results: Five studies containing 19,333 cases were eligible. The meta-analysis revealed that the estimated value of the coefficient of diameter in the Poisson model was −0.2357 with a 95% CI of −0.2743 to −0.1971 (P < .0001). With every 1.0-mm increase in diameter, the failure rate decreased by 0.79 (0.76-0.82) times. In contrast, the failure rate increased by 1.27 (1.22-1.32) times for each 1.0-mm decrease in diameter. The failure rate significantly decreased with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm from 3.63% to 1.79%. Conclusion: The risk of failure decreased correspondingly with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm. Failure is multifactorial; however, increasing the graft diameter as much as possible to match each patient’s anatomic space without overstuffing is an effective precaution that surgeons can take to reduce failures.

Annotating whole genome variants and constructing a multi-classifier based on samples of ADNI.

Alzheimer's disease (AD) is the most common progressive neurodegenerative disorder in the elderly, which will eventually lead to dementia without an effective precaution and treatment. As a typical complex disease, the mechanism of AD's occurrence and development still lacks sufficient understanding. In this study, we aim to directly analyze the relationship between DNA variants and phenotypes based on the whole genome sequencing data. Firstly, to enhance the biological meanings of our study, we annotate the deleterious variants and mapped them to nearest protein coding genes. Then, to eliminate the redundant features and reduce the burden of downstream analysis, a multi-objective evaluation strategy based on entropy theory is applied for ranking all candidate genes. Finally, we use multi-classifier XGBoost for classifying unbalanced data composed with 46 AD samples, 483 mild cognitive impairment (MCI) samples and 279 cognitive normal (CN) samples. The experimental results on real whole genome sequencing data from Alzheimer's Disease Neuroimaging Initiative (ADNI) show that our method not only has satisfactory classification performance but also finds significance correlation between AD and RIN3, a known susceptibility gene of AD. In addition, pathway enrichment analysis was carried out using the top 20 feature genes, and three pathways were confirmed to be significantly related to the formation of AD. From the experimental results, we demonstrated that the efficacy of our proposed method has practical significance.

Imunocromatografic Tests Improving Point-of-Care Management of Respiratory Virus Infection in Children

Background: Respiratory syncytial virus (RSV) and influenza virus (flu) contribute substantially to the overall burden of severe respiratory tract infection in children. However, the molecular etiological diagnostic methods of viral infection are still insufficiently accessible in public hospitals. Rapid immunochromatographic tests can add important information at the point of care, including antiviral or antibiotic indication, viral , and effective precaution measures to prevent outbreaks. The aim of this study was to evaluate this impact for pediatric patients under 5 years of age in our hospital. Methods: We conducted a retrospective, observational study of clinical outcomes of children under 5 years requiring hospitalization from 2013 to 2018 for viral respiratory disease, and who had positive RSV and/or flu immunochromatographic rapid test results. Results: In total, we identified 221 cases: RSV, 193; flu, 6; codetections, 19. (Table 1). The mortality rate was 1.8% (2 cases), and 88% of our patients were &lt;1 year of age. Variables significantly associated with orotracheal intubation, the most intensive intervention, were younger age in months, comorbidities, RSV and flu codetection, and bacterial pneumonia diagnosis during hospitalization. Conclusions: In the multivariate analysis, RSV and flu codetection was associated with the least favorable clinical prognoses. Rapid test diagnosis may provide important information at the point of care, and molecular panels are not yet widely accessible in public hospitals. Hence, we believe that immunochromatographic rapid tests represent a valuable and feasible diagnostic alternative facilitating timely evaluation and treatment implementation.Funding: NoneDisclosures: None

Patients with respiratory symptoms are at greater risk of COVID-19 transmission.

The situation with the ongoing epidemic of coronavirus disease 2019 (COVID-19) that started in Wuhan, China, continued to rapidly evolve. As of 10 March 2020, China had confirmed 80 754 cases of COVID-19 and there had been 3136 deaths. Except for China, 109 other nations have reported 32 555 cases and 878 deaths. The clinical and laboratory characteristics of hospitalized COVID-19 patients were described [[1]Zhang J.J. Dong X. Cao Y. et al.Clinical characteristics of 140 patients infected by SARS-CoV-2 in Wuhan, China.Allergy. 2020 Feb 19; https://doi.org/10.1111/all.14238Google Scholar,[2]Guan W.J. Ni Z.Y. Hu Y. et al.Clinical characteristics of coronavirus disease 2019 in China.N. Engl. J. Med. 2020; (published online Feb 28)https://doi.org/10.1056/NEJMoa2002032Google Scholar]. Cough is one of the most common symptoms at onset of illness [[3]Huang C. Wang Y. Li X. et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24)https://doi.org/10.1016/S0140-6736(20)30183-5Google Scholar]. Here, we described the differences in characteristics of nasopharyngeal swab detection between patients with and without respiratory symptoms. The 82 COVID-19 patients were divided into respiratory symptoms group (26 cases) and non-respiratory symptoms group (56 cases). The two groups were comparable in gender (11 [42.3%] men vs 20 [35.7%] men; P = 0.567) and age (median age, 56 years [IQR, 35–65] vs 51 years [IQR, 36–64]; P = 0.398). Compared with patients who did not presented with respiratory symptoms, those patients who presented with cough were more likely to have longer duration of COVID-19 positive testing by nasopharyngeal swab (median duration, 17 days [IQR, 12–23] vs 13 days [IQR, 6–20]; P = 0.041), and have more stable results of COVID-19 testing by nasopharyngeal swab (24 [92.3%] vs 38 [67.9%], P = 0.016). We believe that patients with respiratory symptoms are more harmful to close contacts. First, the virus can be shed explosively from the COVID-19 patients’ upper respiratory tract into the air through coughing. Second, the duration of virus shedding from nasopharynx was longer. It is an effective precaution to stop droplets spreading by hand or with towel when coughing. After coughing, the importance of frequent and proper hand hygiene should be emphasized. Moreover, strict precautions must be observed when handling the towel contaminated with spittle. One encouraging finding is that the results of nasopharyngeal swabs are more stable in patients with cough symptoms. The incidence of nasopharyngeal swabs testing shown as negative and positive fluctuating repeatedly is less, which provides a basis for clinicians to better grasp the appropriate time to cancel quarantine based on the results of asopharyngeal swabs. Supported by Medical Science Advancement Program (Basical Medical Sciences) of Wuhan University, Grant NO. TFJC2018002. We declare no competing interests.

Impact of glucocorticoid supplementation on reducing perioperative complications in patients on long-term glucocorticoid medication: A propensity score analysis using a nationwide inpatient database

BackgroundPerioperative glucocorticoid supplementation has been suggested as a potentially effective precaution against perioperative adrenal crisis in patients on long-term glucocorticoid medication. MethodsThis retrospective cohort study used a national inpatient database in Japan. We included patients who underwent general surgery and those who received long-term glucocorticoid medication before surgery. A one-to-one propensity score-matched analysis was performed to compare patients who received 100 mg hydrocortisone during surgery with those who received no supplementation. The primary outcome was use of vasopressor agents on the day of surgery. The secondary outcomes included bleeding, perioperative infection, wound dehiscence, postoperative length of stay, and in-hospital mortality. ResultsAmong the 807 propensity score-matched pairs, there was no significant difference in use of vasopressor agents between patients with and without glucocorticoid supplementation (24.5% vs. 21.9%; P = 0.22) and no significant differences in any secondary outcomes. ConclusionsPerioperative glucocorticoid supplementation was not associated with decreased morbidity or mortality.

The usefulness of hand washing during field training to prevent acute respiratory illness in a military training facility.

Hand washing plays a key role in preventing respiratory infection in many clinical settings. However, its effectiveness in preventing acute respiratory illness (ARI) during field training in military training facilities has been not studied.A quasi-interventional study was performed to evaluate the prevalence of ARIs over 4 weeks in a Korean army training center in South Korea from January 2009 to February 2009. A total of 1291 recruits participating in military training for 4 weeks were randomly distributed to 2 battalions (one with 631 and the other with 660). After noticing there is a difference between the 2 battalions in terms of the development of ARIs at the end of 2 weeks of training, we conducted interviews with the battle commanders to determine factors that may be related to one battalion having a higher incidence of ARI. Thereafter, we performed an intervention, which consists of instructing the battalion having a higher incidence of ARI to implement field hand washing from the third week. Following the intervention, we compared the cumulative rate of ARI during 4 weeks of training.The interviews revealed that there were no major differences between the 2 battalions in terms of the training schedules, living environments, or indoor hand washing methods. However, there was difference in terms of hand washing during field training for the first 2 weeks; whereas one battalion (the early hand washing group) implemented hand washing during field training starting in the first week, the other battalion did not implement hand washing for the first 2 weeks but instead began in the third week (the late hand washing group). The cumulative incidence rate of ARI during 4 weeks of training was significantly lower in the early hand washing group (13.0%, 95% confidence interval [CI]: 10.6%–15.9%) than in the late hand washing group (28.0%, 95% CI, 24.7%–31.5%).Our study suggests that outdoor hand washing during field training may be an effective precaution for reducing ARI incidence among recruits participating in military training.

Relationship between sleep-disordered breathing and sleeping position at the 37th week of pregnancy: an observational cross-sectional study

Sleeping in the lateral position during pregnancy can potentially reduce the severity of sleep-disordered breathing (SDB). However, this hypothesis has not been formally investigated in pregnant women. Unlike previous studies that have relied largely on self-reported measures of sleeping position, we investigated the relationship between SDB and sleeping position during late pregnancy using objective measurements. Thirty pregnant women at the 37th gestational week and 30 non-pregnant women (n-Pr) participated in the present study. The pregnant women were divided into 2 groups: those with body mass index (BMI) ≥ 30 kg/m2 (with obesity, p-Ob), and those with BMI < 30 kg/m2 (without obesity, p-nOb). Data were collected using a portable screening device to detect SDB indicated by the respiratory disturbance index (RDI), as well as sleeping position. The occurrence of the lateral sleeping position was higher in pregnant women than in n-Pr (P < 0.05). The total RDI significantly differed among the 3 groups [P < 0.01; p-Ob, 10.7 (3.1); p-nOb, 7.0 (3.0); n-Pr, 4.3 (2.9)]. The p-Ob group showed significantly lower RDI in the lateral position than in the supine position (P = 0.04). Moreover, there was a significant difference in RDI between p-Ob and p-nOb for the supine position (P = 0.001), but there was no between-group difference for the lateral position. Sleeping in the lateral position is likely to mitigate existing SDB in pregnant women with obesity in late pregnancy and may be an effective precaution against undiagnosed SDB and associated complications.

Association between total cholesterol and risk of lung cancer incidence in men: a prospective cohort study

Objective: To assess the association and intensity of baseline TC level with the incidence of lung cancer in men in China. Methods: Since May 2006, all the male workers, including the employees and the retirees in Kailuan Group were recruited in the Kailuan male dynamic cohort study. Information about demographics, medical history, anthropometry and TC level were collected at the baseline interview, as well as the information of newly-diagnosed lung cancer cases during the follow-up period. According to guidelines for blood lipids in Chinese adults and the distribution in the population, TC level was classified into five groups as followed: <160, 160-, 180-, 200- and ≥240 mg/dl, with the second quintile group (160- mg/dl) serving as the referent category. Cox proportional hazards regression model and restricted cubic spline (RCS) model were used to evaluate the association and the nonlinear association between baseline TC level and the risk of lung cancer in the men. Results: By December 31, 2014, for the 109 884 men, a follow up of 763 819.25 person-years was made with a median follow-up period of 7.88 years. During the follow up, 808 lung cancer cases were identified. After adjustment for age, education level, income level, smoking status, alcohol consumption level, history of dust exposure, FPG level and BMI, HR (95%CI) of lung cancer for men with lower TC level (<160 mg/dl) and higher TC level (≥240 mg/dl) were 1.34 (1.04- 1.72) and 1.45 (1.09-1.92), respectively, compared with men with normal TC level (160- mg/dl). The results didn't change significantly after exclusion of newly diagnosed cancer cases within 2 years of follow up and subjects with the history of hyperlipidemia. Conclusion: Our results showed that TC might be associated with higher risk of lung cancer. Men with lower TC level or higher TC level had higher risk for lung cancer. Keep moderate TC level might be one of the effective precaution for the prevention of lung cancer.

The Risk Analysis for Supply Chain Finance Based on Complex Network

The effective control and precaution of financial risks is becoming crucial for supply chain finance services. This paper establishes a supply chain finance system using complex network model approach, comprehensively analyze the network efficiency and network node and further evaluate their influences for supply chain finance risks with a case calculation. The assessment methodology and prevention mechanism for financial risk will provide consult and guidance for supply chain finance services.

Involvement of Spinal PKMζ Expression and Phosphorylation in Remifentanil-Induced Long-Term Hyperalgesia in Rats.

Up-regulation of GluN2B-containing N-methyl-D-aspartate receptors (NMDARs) expression and trafficking is the key mechanism for remifentanil-induced hyperalgesia (RIH), nevertheless, the signaling pathway and pivotal proteins involved in RIH remain equivocal. PKMζ, an isoform of protein kinase C (PKC), maintains pain memory storage in neuropathic pain and inflammatory pain, which plays a parallel role regulated by NMDARs in long-term memory trace. In the present study, ZetaInhibitory Peptide (ZIP), a PKMζ inhibitor, and a selective GluN2B antagonist Ro-256981 are injected intrathecally before remifentanil infusion (1μgkg-1min-1 for 1h, iv) in order to detect whether GluN2B contributes to RIH through affecting synthesis and activity of PKMζ in spinal dorsal horn. Nociceptive tests are measured by Paw withdrawal mechanical threshold (PWT) and paw withdrawal thermal latency (PWL). The L4-L6 segments of dorsal horn taken from rats with RIH are for determining expression of PKMζ and pPKMζ by Western blot and immunohistochemistry. Our data suggest that remifentanil infusion causes an increase of PKMζ in expression and phosphorylation in rats with nociceptive sensitization, beginning at 2h, peaked at 2days, and returned to basal level at 7days. ZIP (10ng) could block behavioral sensitization induced by remifentanil. Ro25-6981 dosage-dependently attenuated mechanical and thermal hyperalgesia and reversed expression of PKMζ and pPKMζ, indicating that GluN2B-containing NMDA receptor facilitates development of RIH through mediating expression and activity of spinal PKMζ in rats. Although detailed mechanisms require further comprehensive study, the preventive role of Ro25-6981 and ZIP provide novel options for the effective precaution of RIH in clinics.

Immune Milk Suppresses Herpes Simplex Virus Type 1.

Immune milk has been developed as a substitute for colostrum and contains a high concentration of IgG antibodies specific to the immunized pathogens. Meanwhile, bovine herpesvirus type-1 (BHV-1) naturally infects cattle worldwide, and its antibody is found in milk. Moreover, BHV-1 glycoprotein K, the major antigen, exhibits substantial homology with human herpes virus simplex 1 (HSV-1) glycoprotein K. On the basis of this evidence, we hypothesized BHV-1 antibody exists in immune milk and suppresses HSV-1 activity. This study investigated whether immune milk IgG recognizes HSV-1 and suppresses HSV-1 activity. IgG in immune milk was purified by affinity Protein A columns, and HSV-1-reactive IgG in immune milk IgG was detected and quantified by ELISA. The efficacy of the IgG against HSV-1 was analyzed using a reduction assay based on the cytopathic effect due to HSV-1 in the presence of macrophages. We detected a high concentration of HSV-1-reactive IgG in immune milk. Furthermore, IgG suppressed HSV-1 pathogenicity in the presence of macrophages. These results indicate immune milk has protective activity against HSV-1 by opsonic activity owing to its high concentration of HSV-1-reactive IgG, which is likely the BHV-1 antibody. HSV-1 is currently a refractory infection with a worldwide distribution. Primary infection occurs via the oral cavity, but there is no effective precaution at this time. However, the present results suggest that taking oral immune milk may be an effective measure to prevent primary HSV-1 infection in the oral cavity.

Radiation dose monitoring and protection of close contacts after implantation of radioactive 125I seeds

Objective To study effective doses, precaution time and safe distance of the close contacts after implantation of radioactive 125I seeds. Methods For the skin effective dose rate, pocket-size radiometer was used. The meter scanned at the point of 30, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140 and 150 cm （simulating close contacts） from the vertical skin surface. Radiation exposure rate meas- urements were obtained from 30 patients who underwent transperineal 125I seed implantation. An algorithm was developed from these measurements to determine effective doses, the precaution time and safety dis- tance. Results For the typical 125I patients, no precautions were required for nonpregnant adults who do not sleep with the patients. At the mean exposure rate, 125I patients should avoid sleeping in contact with nonpregnant adults for 108 days and should avoid keeping in contact with pregnant adults and children for 55 days. Similarly, 125I patients should avoid keeping in contact with coworkers for 78 days. The safety dis- tance of 100 cm was required for nonpregnant adults who do not sleep with the patients, and 60, 120, 140 cm for sleeping in contact with nonpregnant adults, pregnant adults and children, coworkers. Correspond- ingly, the mean radiation effective dose at 100 cm was 0.938 mSv （Std. Deviation： 0. 509） and 3.22 mSv （Std. Dev-iation： 1.97）, 0. 612 mSv （Std. Deviation： 0. 306）, 0. 516 mSv （Std. Deviation： 0. 225） at 60, 120, 140 cm, respectively. Conclusion After 125I seed implantation, time protection and distance protection should be considered to avoid radiation damage for 3.5 months. No protection is required after 3.5 months. Key words: Radioactive 125I seed; Safety distance; Protection

Precaution and treatment measures of complications of peripherally inserted central catheter

Objective To explore the precaution and treatment measures of complications of peripherally inserted central catheter(PICC).Methods 358 clinical data performed as PICC from March 2008 to October 2011 were analyzed retrospectively.Results The complication were observed in 41 patients among 358 cases with a complication rate of 11.5％,including 9 cases with phlebitis(2.5％),6 cases with catheters related infection(1.7％),6 cases with catheter migration(1.7％),13 case with catheter obstruction(3.6％),7 cases with puncture oozing(2.0％).Through correct treatment measures, all the complications were treated satisfactorily.Conclusions Mastering the skill of PICC strictly and taking effective precaution and treatment measures promptly may significantly decrease the complication incidence rates. Key words: Peripherally inserted central catheter (PICC); Complication; Measures

シスプラチン投与後の血清クレアチニン値上昇に関する調査

Cisplatin is a platinum compound used in solid tumor treatment. A dose limiting factor in cisplatin treatment is renal function disorder. Hydration is performed as a precaution at the time of cisplatin dosage. However, a most appropriate hydration method has yet to be established. Therefore, we investigated the serum creatinine rise in patients after cisplatin therapy to clarify an effective hydration method and risk factors of renal function disorder. We administered the treatment of 266 cycles in 111 patients who had received chemotherapy including more than 60 mg/m2 cisplatin in the past. We investigated the infusion solution used for hydration, various patient criteria factors and serum creatinine changes before and after cisplatin dosage. As a result, no significant difference was recognized in age, sex, diuretic dosage, and treatment cycles. However, a significant difference in the ratio of the patients was seen in those whose serum creatinine level increased at an Na load less than 371 mEq (odds ratio: 3.141, 95% confidence interval: 1.174-8.407, p=0.017), whose serum creatinine before the treatment was at more than 85.5% of the normal range upper limit value (4.481, 1.310-15.317, 0.012) and whose cisplatin dose was more than 60.1 mg/m2 (3.565, 1.117-12.493, 0.041). We infer that these are risk factors for a serum creatinine rise with the cisplatin treatment. Providing Na in excess of 371 mEq in hydration seems to be an effective precaution of the renal function disorder.

Boerhaave syndrome as a complication of colonoscopy preparation: a case report

IntroductionColonoscopy is one of the most frequently performed elective and invasive diagnostic interventions. For every colonoscopy, complete colon preparation is mandatory to provide the best possible endoluminal visibility; for example, the patient has to drink a great volume of a non-resorbable solution to flush out all feces. Despite the known possible nauseating side effects of colonoscopy preparation and despite the knowledge that excessive vomiting can cause rupture of the distal esophagus (Boerhaave syndrome), which is a rare but severe complication with high morbidity and mortality, it is not yet a standard procedure to provide a patient with an anti-emetic medication during a colon preparation process. This is the first report of Boerhaave syndrome induced by colonoscopy preparation, and this case strongly suggests that the prospect of being at risk of a severe complication connected with an elective colonoscopy justifies a non-invasive, inexpensive yet effective precaution such as an anti-emetic co-medication during the colonoscopy preparation process.Case presentationA 73-year-old Caucasian woman was scheduled to undergo elective colonoscopy. For the colonoscopy preparation at home she received commercially available bags containing soluble polyethylene glycol powder. No anti-emetic medication was prescribed. After drinking the prepared solution she had to vomit excessively and experienced a sudden and intense pain in her back. An immediate computed tomography (CT) scan revealed a rupture of the distal esophagus (Boerhaave syndrome). After initial conservative treatment by endoluminal sponge vacuum therapy, she was taken to the operating theatre and the longitudinal esophageal rupture was closed by direct suture and gastric fundoplication (Nissen procedure). She recovered completely and was discharged three weeks after the initial event.ConclusionsTo the best of our knowledge, this is the first report of a case of Boerhaave syndrome as a complication of excessive vomiting caused by colonoscopy preparation. The case suggests that patients who are prepared for a colonoscopy by drinking large volumes of fluid should routinely receive an anti-emetic medication during the preparation process, especially when they have a tendency to nausea and vomiting.

Percutaneous Tracheostomy: 2 Unique Cases of Stridor Managed in KVG Medical College Hospital.

nbspBackground Percutaneous tracheostomy to a large extent has replaced conventional surgical tracheostomy by virtue of its low incidence of complications and the rapidity with which the procedure can be performed at the bedside avoiding transport of critically ill patients to the operating rooms. Since it is a blind approach bronchoscopic guidance has been suggested which is not always possible because of economic constraints. MethodsA case study of 2 patients who had guide wire dilating forceps technique of percutaneous tracheostomy without the aid of a bronchoscope have been reported here. By ensuring the free mobility of the guide wire at each step of the procedure a safe placement of the tracheostomy tube was achieved. Results The mean operating time in both the cases was nearly 6 minutes. Both the patients did not have any complications. Both the patients were tracheotomised for permanent indication. One had severe dysphagia amp TEF and could not survive long even after feeding gastrostomy. Other patient was referred to radiotherapy for stage IV supraglottic carcinoma larynx. Conclusion In the absence of bronchoscopic guidance adopting the simple but effective precaution of free movement of guide wire at each step of the procedure a safe tracheostomy tube placement is possible in an emergency as described in our report.

Negligence, Strict Liability and Collective Action

Conventional wisdom in law and economics has long been that negligence-based regimes induce optimal care but encourage excessive activity. This paper demonstrates that when behavior involves multiple victims or injurers, negligence-based regimes can create a collective action problem which results in sub-optimal care and insufficient activity. As we show, investments in effective precaution often become cost-justified only when multiple parties engage in high activity levels. If parties are not coordinated, however, each may choose a low activity level to minimize her risk of harm. This collective action problem provides several insights for policymakers and legislatures regarding the design of optimal liability rules. It sheds new light on the efficiency of applying negligence, strict liability, or a combination of these two regimes; presents an overlooked virtue of damage caps and negligence per-se rules; and justifies doctrines that limit joint tortfeasors’ exposure to liability.

Universal precautions in the era of HIV/AIDS: perception of health service providers in Yunnan, China.

With a rising HIV/AIDS epidemic, it has become especially important for health service providers in China to understand and correctly adhere to universal precautions. Using qualitative interview data, perspectives from both health administrators and service providers working at all levels of China's health care system were examined. Service providers admitted selective adherence and non-adherence to universal precautions in their daily medical practice, and gave their explanations for such behaviors. Lack of time to put on protective gear, gear's interference with medical procedures, lack of administrative support, heavy workload in hospitals, inaccurate risk assessment, and beliefs that compliance with universal precautions is unnecessary, time consuming and costly were mentioned as reasons behind noncompliance. Effective universal precaution interventions need to target both administrators and providers, and address both structural barriers and individual attitudinal and behavioral factors.

Make up your own minds

Hands up if you are over 50 and take an aspirin a day, or if you advise your older patients and friends to do this. It may seem a harmless and effective precaution against potentially devastating vascular events. But do the benefits outweigh the risks? Should it be offered as primary prevention to everyone over 50, or just to those at increased risk? This week, two commentators explore the evidence for and against aspirin for everyone over 50 (pp 1440,1442). In favour of such a policy, Peter Elwood and colleagues argue that about 80% of men and 50% of women in the …