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1.
Clin Oral Investig ; 25(1): 151-157, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32542583

RESUMO

OBJECTIVE: The aim of this study was to compare the cyclic fatigue resistance at body temperature and phase transformation behaviors of novel Rotate instrument (25.06) with rotating Mtwo (25.06) and reciprocating Reciproc Blue (25.08) and Reciproc (25.08) instruments. MATERIALS AND METHODS: The Rotate, Reciproc Blue, Reciproc, and Mtwo instruments free of visible deformations were collected and tested in a static cyclic fatigue test method, which has a ceramic block containing an artificial canal with 60° angle of curvature and a 5-mm radius of curvature at 37 °C (n = 16). All instruments were operated until fracture occurred, and both time to fracture (TF) and the lengths of the fractured fragments were recorded. TF data was analyzed with one-way ANOVA followed by post hoc Tukey tests and Weibull analysis, and fractured fragment length data were subjected to one-way ANOVA and post hoc Tukey tests (P < 0.05). Two unused instruments from each brand were also subjected to differential scanning calorimetry (DSC) analysis to determine their phase transformation temperatures. RESULTS: The Reciproc Blue instruments showed significantly higher TF values and reliability than the other groups (P < 0.05). Rotate instruments exhibited greater cyclic fatigue resistance than the Reciproc and Mtwo instruments (P < 0.05). No significant difference was detected among the fractured fragment lengths (P > 0.05). The lowest austenite finish temperature was exhibited by the Mtwo, which presented a single transformation peak, followed by the Rotate, Reciproc Blue, and Reciproc instruments which all presented two peaks during transformation. CONCLUSIONS: Cyclic fatigue resistance of instruments manufactured from thermally treated Blue wire instruments was superior to those of the Mtwo and Reciproc, whereas reciprocating the Blue wire showed the highest resistance. CLINICAL RELEVANCE: The present study compared the cyclic fatigue resistance of the novel Rotate instrument with similar instruments manufactured from conventional nickel-titanium, m-wire, and Blue wire at body temperature and reported that Blue-treated instruments exhibited superior cyclic fatigue resistance.


Assuntos
Instrumentos Odontológicos , Níquel , Temperatura Corporal , Ligas Dentárias , Desenho de Equipamento , Falha de Equipamento , Teste de Materiais , Reprodutibilidade dos Testes , Preparo de Canal Radicular , Estresse Mecânico , Temperatura , Titânio
2.
BMC Nephrol ; 21(1): 486, 2020 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198670

RESUMO

BACKGROUND: Critically ill coronavirus disease 2019 (COVID-19) patients have a high risk of acute kidney injury (AKI) that requires renal replacement therapy (RRT). A state of hypercoagulability reduces circuit life spans. To maintain circuit patency and therapeutic efficiency, an optimized anticoagulation strategy is needed. This study investigates whether alternative anticoagulation strategies for RRT during COVID-19 are superior to administration of unfractionated heparin (UFH). METHODS: Retrospective cohort study on 71 critically ill COVID-19 patients (≥18 years), admitted to intensive care units at a tertiary health care facility in the southwestern part of Germany between February 26 and May 21, 2020. We collected data on the disease course, AKI, RRT, and thromboembolic events. Four different anticoagulatory regimens were administered. Anticoagulation during continuous veno-venous hemodialysis (CVVHD) was performed with UFH or citrate. Anticoagulation during sustained low-efficiency daily dialysis (SLEDD) was performed with UFH, argatroban, or low molecular weight heparin (LMWH). Primary outcome is the effect of the anticoagulation regimen on mean treatment times of RRT. RESULTS: In patients receiving CVVHD, mean treatment time in the UFH group was 21.3 h (SEM: ±5.6 h), in the citrate group 45.6 h (SEM: ±2.7 h). Citrate anticoagulation significantly prolonged treatment times by 24.4 h (P = .001). In patients receiving SLEDD, mean treatment time with UFH was 8.1 h (SEM: ±1.3 h), with argatroban 8.0 h (SEM: ±0.9 h), and with LMWH 11.8 h (SEM: ±0.5 h). LMWH significantly prolonged treatment times by 3.7 h (P = .008) and 3.8 h (P = .002), respectively. CONCLUSIONS: UFH fails to prevent early clotting events in the dialysis circuit during COVID-19. For patients, who do not require effective systemic anticoagulation, regional citrate dialysis is the most effective strategy. For patients, who require effective systemic anticoagulation, the usage of LMWH results in the longest circuit life spans. The proposed anticoagulatory strategies are safe, can easily be monitored, and allow an individualized treatment.


Assuntos
Lesão Renal Aguda/terapia , Anticoagulantes/administração & dosagem , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Terapia de Substituição Renal/métodos , Lesão Renal Aguda/sangue , Lesão Renal Aguda/epidemiologia , Adulto , Idoso , Arginina/análogos & derivados , Coagulação Sanguínea , Ácido Cítrico/administração & dosagem , Comorbidade , Infecções por Coronavirus/sangue , Cuidados Críticos , Estado Terminal , Falha de Equipamento , Feminino , Alemanha/epidemiologia , Heparina/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Ácidos Pipecólicos/administração & dosagem , Pneumonia Viral/sangue , Terapia de Substituição Renal/instrumentação , Estudos Retrospectivos , Sulfonamidas , Centros de Atenção Terciária
3.
Biomed Eng Online ; 19(1): 75, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008462

RESUMO

BACKGROUND: The world is facing an unprecedented outbreak affecting all aspects of human lives which is caused by the COVID-19 pandemic. Due to the virus novelty, healthcare systems are challenged by a high rate of patients and the shortage of medical products. To address an increased need for essential medical products, national authorities, worldwide, made various legislative concessions. This has led to essential medical products being produced by automotive, textile and other companies from various industries and approved under the emergency use authorizations or legal concessions of national regulatory bodies. This paper presents a narrative commentary of the available documentation on emergency use authorizations and legal concessions for medical products during COVID-19 pandemic. METHODOLOGY: The basis for narrative commentary includes scientific articles published in Web of Science, Scopus, PubMed and Embase databases, official publications of international organizations: Food and Drug Agency (FDA), World Health Organisation (WHO), World Bank and United Nations (UN), and national regulatory agency reports in native languages (English, German, Bosnian, and Croatian) published from November 1, 2019 to May 1, 2020. This paper focuses on three types of essential medical products: mechanical ventilators, personal protective equipment (PPE) and diagnostic tests. Evidence-informed commentary of available data and potential identified risks of emergency use authorizations and legal concessions is presented. DISCUSSION: It is recognized that now more than ever, raising global awareness and knowledge about the importance of respecting the essential requirements is needed to guarantee the appropriate quality, performance and safety of medical products, especially during outbreak situation, such as the COVID-19 pandemic. Emergency use authorizations for production, import and approval of medical products should be strictly specified and clearly targeted from case to case and should not be general or universal for all medical products, because all of them are associated with different risk level. CONCLUSION: Presented considerations and experiences should be taken as a guide for all possible future outbreak situations to prevent improvised reactions of national regulatory bodies.


Assuntos
Betacoronavirus , Comércio/legislação & jurisprudência , Infecções por Coronavirus , Licenciamento/legislação & jurisprudência , Indústria Manufatureira/legislação & jurisprudência , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral , Kit de Reagentes para Diagnóstico/provisão & distribução , Ventiladores Mecânicos/provisão & distribução , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Falha de Equipamento , União Europeia , Saúde Global , Humanos , Equipamento de Proteção Individual/normas , Kit de Reagentes para Diagnóstico/normas , Medição de Risco , Estados Unidos , United States Food and Drug Administration , Ventiladores Mecânicos/normas
4.
J Med Life ; 13(3): 378-381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072211

RESUMO

Although benefiting from an unprecedented technological evolution, contemporary endodontics is still characterized by the recurrence of retreatments, due to the need to solve quite frequent incidents, accidents, or even failures of primary endodontic treatment. This survey aims to assess both the etiology and the prevention methods of one of the most troublesome endodontic iatrogenies: instrument separation during root canal shaping. The multifactorial nature of this occurrence entails identifying and taking into account all the causal and contributing factors. Their significant number and the possible involvement of any of them, starting with the complexity and variability of the root canals and ending with the technical specifications concerning the nickel-titanium rotary instrumentation system being used, highlight the necessity to develop valid guidelines to avert the occurring of such an upsetting situation.


Assuntos
Endodontia , Doença Iatrogênica/prevenção & controle , Preparo de Canal Radicular/instrumentação , Falha de Equipamento , Humanos , Níquel , Titânio
5.
Curr Opin Anaesthesiol ; 33(6): 788-792, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33093302

RESUMO

PURPOSE OF REVIEW: The goal of automation is to decrease the anesthesiologist's workload and to decrease the possibility of human error. Automated systems introduce problems of its own, however, including loss of situation awareness, leaving the physician out of the loop, and training physicians how to monitor autonomous systems. This review will discuss the growing role of automated systems in healthcare and describe two types of automation failures. RECENT FINDINGS: An automation surprise occurs when an automated system takes an action that is unexpected by the user. Mode confusion occurs when the operator does not understand what an automated system is programmed to do and may prevent the clinician from fully understanding what the device is doing during a critical event. Both types of automation failures can decrease a clinician's trust in the system. They may also prevent a clinician from regaining control of a failed system (e.g., a ventilator that is no longer working) during a critical event. SUMMARY: Clinicians should receive generalized training on how to manage automation and should also be required to demonstrate competency before using medical equipment that employs automation, including electronic health records, infusion pumps, and ventilators.


Assuntos
Anestesia/métodos , Anestésicos/administração & dosagem , Automação/métodos , Segurança do Paciente , Falha de Equipamento , Humanos , Carga de Trabalho
6.
Niger J Clin Pract ; 23(10): 1443-1448, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047704

RESUMO

Aim: The aim of this study was to evaluate the effect of the different rotational speeds and creating a glide path on cyclic fatigue resistance of XP-endo Shaper® (XPS) (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) at intracanal temperature. Materials and Methods: Ninety-six XPS files were divided into 6 groups [directly used at 1000 rpm (G1) or 3000 rpm (G4), with glide path at 1000 rpm (G2) or 3000 rpm (G4), without glide path at 1000 rpm (G3) and 3000 rpm (G6)]. All the instruments were rotated in a stainless-steel artificial canal with a 75° angle of curvature, 7.5 mm radius of curvature, and 1.3 mm inner diameter until the fracture occurred. The number of cycles to failure (NCF) and the length of the fractured (LF) segments were evaluated. Weibull analysis, one-way ANOVA, and Tukey multiple comparison tests were performed with the significance level set at 0.05. Results: NCF of 3000 rpm groups was statistically higher than that of 1000 rpm groups (P < 0.05). And time to fracture was found statistically higher in 1000 rpm as compared to 3000 rpm. The mean LF of the instruments was statistically insignificant (P > 0.05). There was no statistical difference within the groups subjected at 1000 rpm and 3000 rpm files used with or without a glide path (P > 0.05). Conclusion: Within the limitations of this in vitro study, it was determined that XPS can be used safely even at 3000 rpm speed with or without glide path.


Assuntos
Instrumentos Odontológicos , Preparo de Canal Radicular/instrumentação , Falha de Equipamento , Humanos , Estresse Mecânico , Torção Mecânica
7.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(5): 467-470, 2020 Oct 08.
Artigo em Chinês | MEDLINE | ID: mdl-33047576

RESUMO

This paper is a summary of the three types of faults that have occurred in the recent years in the Carestream DR7500:hardware failure, software failure, and communication failure. The specific cases of three types of faults are introduced in a case-by-case basis.


Assuntos
Manutenção , Intensificação de Imagem Radiográfica , Falha de Equipamento
8.
J Contemp Dent Pract ; 21(7): 728-732, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33020354

RESUMO

AIM: The aim of the present study is twofold: to evaluate cyclic fatigue resistance differences of two different nickel-titanium rotary instruments, brand new and after an ex vivo instrumentation of single root extracted teeth. MATERIALS AND METHODS: Twenty new S One 20.06 were randomly divided into two groups. The first group (n = 10) was immediately subjected to a cyclic fatigue test (S One Group I). The second group (n = 10) (S one Group II) performed a cyclic fatigue test after three ex vivo root canal treatment with a single-file technique. The same process has been carried out for 20 M-Two 20.06 instruments. RESULTS: Mean time to fracture (TtF) for Group I was 51.14 ± 1.28 for S One and 32.62 ± 0.17 for M-Two 20.06 and for Group II was 46.00 ± 0.99 for S One and 27.75 ± 1.58 for M-Two 20.06. The reduction in TtF values from Group I to Group II was 11% for S One and 15% for M-Two. Statistical analysis found significant differences in all the groups examined (p value < 0.05). Mean fragment length (FL) for Group I was 3.07 ± 0.17 for S One and 3.05 ± 0.14 for M-Two 20.06 and for Group II was 3.05 ± 0.07 for S One and 3.05 ± 0.14 for M-Two 20.06. Statistical analysis was pursued, and no significant difference was found (p value > 0.05). CONCLUSION: The S-One showed significantly more resistance to cyclic fatigue stress than M-Two for both new and used instruments. This validates the hypothesis that the AF H wire enables the S One files to endure more the cyclic fatigue stresses. CLINICAL SIGNIFICANCE: This study demonstrates the cyclic fatigue resistance of a new endodontic instrument after repetitive usage.


Assuntos
Níquel , Titânio , Cavidade Pulpar , Desenho de Equipamento , Falha de Equipamento , Teste de Materiais , Preparo de Canal Radicular
9.
J Vasc Access ; 21(5): 795-798, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32886031

RESUMO

INTRODUCTION: Breakage and fragment embolization is a rare but feared complication of peripherally inserted central catheter use. While chest radiographs are no longer the gold standard for determining peripherally inserted central catheter tip position, their use in diagnosing complications is still warranted. We report a case of occult catheter embolization discovered by routine chest X-ray. CASE DESCRIPTION: A patient with a right brachial vein peripherally inserted central catheter was admitted to our Emergency Department for palpitations and dyspnea. The peripherally inserted central catheter was not visible at presentation, and she was unclear as to what had happened; she left the Emergency Department before workup was performed. Catheter embolization was discovered upon implantation of a new peripherally inserted central catheter. CONCLUSION: Although routine chest radiographs are no longer necessary after peripherally inserted central catheter implantation, they are in diagnosing peripherally inserted central catheter-related complications even in asymptomatic patients. We discuss their use and the possible role of securement devices in preventing some instances of catheter embolization.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Migração de Corpo Estranho/diagnóstico por imagem , Radiografia Torácica , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Remoção de Dispositivo , Falha de Equipamento , Feminino , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/terapia , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do Tratamento
11.
Artigo em Inglês | MEDLINE | ID: mdl-32899922

RESUMO

Since the emergence of the COVID-19 pandemic, the use of face masks by healthy individuals for prevention has been attracting public attention. However, efficacy depends on proper usage. We set out to determine the prevalence of wearing masks to prevent COVID-19 and compliance with appropriate measures for the correct use of face masks among the general public in Japan where wearing medical masks is a "cultural" normality. This cross-sectional study was based on an internet-based survey completed by 2141 people (50.8% men, aged 20-79 years) who were selected among registrants of an Internet research company between 1 April and 6 April 2020. Participants were asked to indicate how often they wore masks for prevention and to what extent they practiced appropriate measures suggested by the World Health Organization. The prevalence of wearing masks was 80.9% and compliance rates with appropriate measures ranged from 38.3% to 83.5%. Only 23.1% complied with all recommendations. Compliance rates were overall low in men and persons with low household incomes. Our results, hence show that many citizens implement inaccurate measures when using face masks. Therefore, providing guidance on correct usage is essential when encouraging the use of face masks to prevent COVID-19.


Assuntos
Infecções por Coronavirus/prevenção & controle , Falha de Equipamento , Máscaras , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Idoso , Betacoronavirus , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Int Heart J ; 61(5): 913-921, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921668

RESUMO

Previous study has identified marked differences in patient characteristics and causes of inappropriate shock (IAS) between Japan and the Western societies in terms of subcutaneous implantable cardioverter-defibrillator (S-ICD). However, evidence of IAS in Asian populations including Japan has been limited to one observational study.Thus, we conducted a single-center registry study that tracks the postoperative course of 61 consecutive patients who received S-ICD from February 2016 to January 2020. Our findings showed that IAS occurred in 9.8% of the study population (6/61), which is comparable to the previously reported incidence. Remarkably, T-wave oversensing did not result in an IAS (0/6). Instead, myopotential oversensing was determined to have caused the most IAS events (4/6), while atrial fibrillation ranked second (2/6). A provocation maneuver (e.g., abdominal clench, push-ups, lifting a heavy item) reproduced myopotential noise disguised as R-waves, which should potentially trigger an IAS if uninterrupted. R-wave amplitude of the IAS group appeared relatively low compared to that of the non-IAS group although this finding was not tested significant. Furthermore, no temporal changes were noted in R-wave amplitude between the time of implantation and IAS events, suggesting that it is neither constantly low nor acutely dropped R-wave amplitude but a relatively high noise level that drives IAS. All the myopotential-IAS patients were found to be male. Right-sided lead implantation was associated with a higher incidence of IAS.This study highlights the fact that IAS continues to occur due to myopotential noise oversensing instead of T-wave oversensing. To minimize the risk of IAS, it is desirable to search and secure high R-wave voltage.


Assuntos
Desfibriladores Implantáveis , Cardioversão Elétrica/estatística & dados numéricos , Músculo Esquelético/fisiologia , Taquicardia Ventricular/diagnóstico , Fibrilação Ventricular/diagnóstico , Adolescente , Adulto , Idoso , Criança , Erros de Diagnóstico , Falha de Equipamento , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Adulto Jovem
13.
J Endod ; 46(12): 1884-1893, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32898557

RESUMO

INTRODUCTION: This study aimed to compare the ProTaper Universal (PTU; Dentsply Maillefer, Ballaigues, Switzerland) system with 6 replicalike instruments regarding instrument design, mechanical performance, and alloy characteristics. METHODS: New rotary instruments (size 20/.07v) of PTU and 6 replicalike systems (EdgeTaper [EdgeEndo, Johnson City, TN], U-File [Dentmark, Ludhiana, India], Go-Taper Universal [Access, Shenzhen, China], Super Files [Flydent, Shenzhen, China], Multitaper [Proclinic Expert, Besançon, France], and Pluri Taper [Bestdent, Shenzhen, China]) (n = 329) were selected and evaluated regarding their design, mechanical performance, and metallurgical characteristics. The results were compared using the nonparametric Mood median test and 1-way analysis of variance with the significance level set at 0.05. RESULTS: Replicalike instruments were similar to PTU regarding design, maximum torque to fracture (P > .05), and ratio of nickel and titanium elements. Scanning electron microscopy revealed differences in the geometry of the tip and finishing surfaces. Time to fracture of Go-Taper Universal (50.0 seconds) was similar to PTU (44.0 seconds) (P > .05), but the U-File (63.5 seconds), Edge Taper (87.5 seconds), and Super Files (130 seconds) showed significantly higher values (P < .05). The highest maximum torque was observed in the Super Files instrument (P < .05), but no statistical difference was noted among the other instruments (P > .05). The angle of rotation before rupture of the Multitaper (574°) and Pluri Taper (481°) was higher than PTU (354°) (P < .05). Differential scanning calorimetric analysis showed clear differences on the transformation temperatures among the tested instruments. The R-phase start and finish temperatures of PTU were 11.0°C and -18.0°C, respectively. CONCLUSIONS: Overall, replicalike instruments were similar to PTU regarding the torsional resistance, geometric design, and near equiatomic proportions of nickel and titanium elements. In 3 of the 4 mechanical tests, the EdgeTaper (torque, angle of rotation, and bending load) and Go-Taper Universal (time to fracture, torque, and angle of rotation) systems were similar to PTU.


Assuntos
Ligas Dentárias , Preparo de Canal Radicular , China , Desenho de Equipamento , Falha de Equipamento , França , Índia , Teste de Materiais , Estresse Mecânico , Titânio , Torção Mecânica
14.
Skeletal Radiol ; 49(11): 1873-1877, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32827082

RESUMO

The ongoing coronavirus disease 2019 (COVID-19) pandemic has increased the need for safe and efficient testing as a key containment strategy. Drive-through testing with nasopharyngeal swab has been implemented in many places in the USA as it allows for expeditious testing of large numbers of patients, limits healthcare workers' risk of exposure, and minimizes the use of personal protective equipment. We present a case where the aluminum shaft of the nasopharyngeal swab fractured during specimen collection at a drive-through testing facility and was suspected to have remained in the asymptomatic patient. Initial evaluation with a series of radiographs covering the skull base, neck, chest, and abdomen did not reveal the swab. On further clinical evaluation, the swab was found endoscopically, lodged between the left inferior turbinate and nasal floor, and was removed by an otorhinolaryngologist. Using a phantom model, we aimed to delineate an imaging technique to better visualize the aluminum shaft of the nasopharyngeal swab on radiographs to help in identification. A technique using lower tube voltage (kVp) with tight collimation centered at the nasal bones area produced the best visualization of the aluminum shaft of the swab. Recognition that aluminum foreign bodies may be difficult to visualize radiographically and  optimization of radiograph acquisition technique may help guide clinical management in unusual cases. Further evaluation with computed tomography or endoscopy should be considered in suspected cases where radiographs are negative.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/instrumentação , Infecções por Coronavirus/diagnóstico , Falha de Equipamento , Corpos Estranhos/diagnóstico por imagem , Pneumonia Viral/diagnóstico , Manejo de Espécimes/instrumentação , Idoso de 80 Anos ou mais , Alumínio , Humanos , Masculino , Pandemias , Radiografia/métodos , Instrumentos Cirúrgicos
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(8): 1036-1040, 2020 Aug 15.
Artigo em Chinês | MEDLINE | ID: mdl-32794675

RESUMO

At present, the 2019-nCoV epidemic situation is in severe and complex period. In order to prevent the virus from invading and infecting, it is very important and urgent for medical personnel to protect themselves. However, in the process of using protective equipment by medical personnel, the performance of device related pressure injuries (DRPI) caused by pain, numbness, redness, and even breakage caused by the equipment has seriously endangered the health of medical personnel. This article, based on Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide 2019, references, and clinical experiences of wound specialists in West China Hospital of Sichuan University, summarize the preventive and protective measures of West China Hospital for medical personnel to prevent DRPI, so as to provide clinical preventive measurements for medical personnel.


Assuntos
Infecções por Coronavirus/epidemiologia , Falha de Equipamento , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/epidemiologia , Ferimentos e Lesões/prevenção & controle , Betacoronavirus , China , Pessoal de Saúde , Humanos , Pandemias , Pressão
17.
J Oral Maxillofac Surg ; 78(11): 1922-1925, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32768404

RESUMO

This report describes a case of needle breakage during a left-sided inferior alveolar nerve block to perform restorative dentistry on a 56-year-old male patient. The needle was removed in conjunction with interventional neuroradiology using biplanar fluoroscopy.


Assuntos
Corpos Estranhos , Bloqueio Nervoso , Falha de Equipamento , Fluoroscopia , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas
18.
Dtsch Arztebl Int ; 117(22-23): 404, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32762836
19.
Artigo em Inglês | MEDLINE | ID: mdl-32784845

RESUMO

The main purpose of the study was to explore the effects of carrying police equipment on spatiotemporal and kinetic gait parameters. Two-hundred and seventy-five healthy men and women attending police academy (32% women) were randomly recruited. Gait analysis without and with a police equipment load (≈3.5 kg) was analyzed using the Zebris pressure platform. Differences and effect sizes were calculated using a Student t-test and Wilcoxon test for dependent samples and Cohen's D statistics. In both men and women, carrying police equipment significantly increased the foot rotation (effect size 0.13-0.25), step width (0.13-0.33), step time (0.25), stride time (0.13-0.25) and peak plantar pressure beneath the forefoot (0.16-0.30), midfoot (0.15-0.32) and hindfoot (0.13-0.25) region of the foot. Significant reductions in the step length (0.12-0.25), stride length (0.14-0.23), cadence (0.15-0.28) and walking speed (0.20-0.22) were observed in both sexes. Although significant, the effect sizes were mostly trivial in men and small in women. Our study shows significant changes in the spatiotemporal and kinetic gait parameters when carrying police equipment for both men and women. Although the effect sizes are trivial to small, carrying police equipment of ≈3.5 kg may have a negative impact on gait characteristics in first-year police officers.


Assuntos
Marcha , Polícia , Caminhada , Adulto , Fenômenos Biomecânicos , Falha de Equipamento , Feminino , , Humanos , Masculino , Adulto Jovem
20.
N Engl J Med ; 383(6): 526-536, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32757521

RESUMO

BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (ICD) was designed to avoid complications related to the transvenous ICD lead by using an entirely extrathoracic placement. Evidence comparing these systems has been based primarily on observational studies. METHODS: We conducted a noninferiority trial in which patients with an indication for an ICD but no indication for pacing were assigned to receive a subcutaneous ICD or transvenous ICD. The primary end point was the composite of device-related complications and inappropriate shocks; the noninferiority margin for the upper boundary of the 95% confidence interval for the hazard ratio (subcutaneous ICD vs. transvenous ICD) was 1.45. A superiority analysis was prespecified if noninferiority was established. Secondary end points included death and appropriate shocks. RESULTS: A total of 849 patients (426 in the subcutaneous ICD group and 423 in the transvenous ICD group) were included in the analyses. At a median follow-up of 49.1 months, a primary end-point event occurred in 68 patients in the subcutaneous ICD group and in 68 patients in the transvenous ICD group (48-month Kaplan-Meier estimated cumulative incidence, 15.1% and 15.7%, respectively; hazard ratio, 0.99; 95% confidence interval [CI], 0.71 to 1.39; P = 0.01 for noninferiority; P = 0.95 for superiority). Device-related complications occurred in 31 patients in the subcutaneous ICD group and in 44 in the transvenous ICD group (hazard ratio, 0.69; 95% CI, 0.44 to 1.09); inappropriate shocks occurred in 41 and 29 patients, respectively (hazard ratio, 1.43; 95% CI, 0.89 to 2.30). Death occurred in 83 patients in the subcutaneous ICD group and in 68 in the transvenous ICD group (hazard ratio, 1.23; 95% CI, 0.89 to 1.70); appropriate shocks occurred in 83 and 57 patients, respectively (hazard ratio, 1.52; 95% CI, 1.08 to 2.12). CONCLUSIONS: In patients with an indication for an ICD but no indication for pacing, the subcutaneous ICD was noninferior to the transvenous ICD with respect to device-related complications and inappropriate shocks. (Funded by Boston Scientific; PRAETORIAN ClinicalTrials.gov number, NCT01296022.).


Assuntos
Arritmias Cardíacas/terapia , Desfibriladores Implantáveis/efeitos adversos , Idoso , Cardiomiopatias/terapia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Eletrodos Implantados/efeitos adversos , Falha de Equipamento , Feminino , Seguimentos , Cardiopatias/terapia , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Desenho de Prótese
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