Use of intra-osseous access in adults: a systematic review

BACKGROUND: Indications for intra-osseous (IO) infusion are increasing in adults requiring administration of fluids and medications during initial resuscitation. However, this route is rarely used nowadays due to a lack of knowlegde and training. We reviewed the current evidence for its use in adults requiring resuscitative procedures, the contraindications of the technique, and modalities for catheter implementation and skill acquisition. METHODS: A PubMed search for all articles published up to December 2015 was performed by using the terms “Intra-osseous” AND “Adult”. Additional articles were included by using the “related citations” feature of PubMed or checking references of selected articles. Editorials, comments and case reports were excluded. Abstracts of all the articles that the search yielded were independently screened for eligibility by two authors and included in the analysis after mutual consensus. In total, 84 full-text articles were reviewed and 49 of these were useful for answering the following question “when, how, and for which population should an IO infusion be used in adults” were selected to prepare independent drafts. Once this step had been completed, all authors met, reviewed the drafts together, resolved disagreements by consensus with all the authors, and decided on the final version. RESULTS: IO infusion should be implemented in all critical situations when peripheral venous access is not easily obtainable. Contraindications are few and complications are uncommon, most of the time bound to prolonged use. The IO infusion allows for blood sampling and administration of virtually all types of fluids and medications including vasopressors, with a bioavailability close to the intravenous route. Unfortunately, IO infusion remains underused in adults even though learning the technique is rapid and easy. CONCLUSIONS: Indications for IO infusion use in adults requiring urgent parenteral access and having difficult intravenous access are increasing. Physicians working in emergency departments or intensive care units should learn the procedures for catheter insertion and maintenance, the contraindications of the technique, and the possibilities this access offers. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-016-1277-6) contains supplementary material, which is available to authorized users

Address block location on flat mail pieces by a bottom-up segmentation method. Evaluation and optimization

We present a textual areas segmentation method for complex documents not or few structured. This method is applied to the address block location on large mail pieces . Among these objects, we have identified two main classes and we present a dedicated method for each . We then give more details about the optimization and evaluation of the implemented techniques .Nous présentons une méthode de segmentation des zones de texte sur des documents complexes, peu ou pas structurés. Cette méthode est appliquée à la localisation du bloc adresse sur les grands objets postaux. Parmi ces objets, nous avons identifié deux catégories principales et nous présentons une méthode adaptée à chacune. Nous portons enfin une attention particulière sur la phase d'optimisation des traitements et d'évaluation des performances

Modelling Blood Flow and Metabolism in the Preclinical Neonatal Brain during and Following Hypoxic-Ischaemia

Hypoxia-ischaemia (HI) is a major cause of neonatal brain injury, often leading to long-term damage or death. In order to improve understanding and test new treatments, piglets are used as preclinical models for human neonates. We have extended an earlier computational model of piglet cerebral physiology for application to multimodal experimental data recorded during episodes of induced HI. The data include monitoring with near-infrared spectroscopy (NIRS) and magnetic resonance spectroscopy (MRS), and the model simulates the circulatory and metabolic processes that give rise to the measured signals. Model extensions include simulation of the carotid arterial occlusion used to induce HI, inclusion of cytoplasmic pH, and loss of metabolic function due to cell death. Model behaviour is compared to data from two piglets, one of which recovered following HI while the other did not. Behaviourally-important model parameters are identified via sensitivity analysis, and these are optimised to simulate the experimental data. For the non-recovering piglet, we investigate several state changes that might explain why some MRS and NIRS signals do not return to their baseline values following the HI insult. We discover that the model can explain this failure better when we include, among other factors such as mitochondrial uncoupling and poor cerebral blood flow restoration, the death of around 40% of the brain tissue. Copyright

Extração semiautomática de contornos de telhado de edifícios com base em snakes e programação dinâmica

Este trabalho apresenta um método para a extração de contornos de telhado de edifícios a partir de imagens digitais tomadas sobre cenas urbanas complexas. O método proposto é baseado na otimização de uma função de energia snakes, que representa contornos de telhado de edifícios em imagens digitais, através da técnica de otimização por programação dinâmica. Como a grande maioria dos contornos de telhado de edifícios possui lados retilíneos se interceptando em ângulos retos, foram aplicadas restrições à função de energia snakes de modo a atender esta condição geométrica. A principal vantagem de se usar o algoritmo de programação dinâmica para otimizar a função de energia snakes é o aumento do raio de convergência, quando comparado com o que é normalmente obtido na solução original baseada em cálculo variacional. A avaliação experimental foi realizada a partir de dados reais e os resultados obtidos na inspeção visual e análise numérica dos experimentos mostraram o potencial do método para a extração de contornos de telhado de edifícios a partir de imagens digitais.This paper presents a method for building roof contours extraction from digital image taken over complex urban scenes. The proposed method is based on the optimization of a snakes' energy function that represents building roof contours in digital images by using the dynamic programming optimization technique. As most of the building roof contours contains straight edges intercepting at right angles, appropriate geometrics constraints are enforced into the original snakes' energy function. The main advantage of using the dynamic programming algorithm for optimizing the snakes' energy function is the augmentation of the pull-in-range, when compared to the one that is usually obtained in the original solution based on variational approaches. Experimental evaluation, including visual inspection and numeric analysis, was performed by using real data and the obtained results showed the potentiality of the proposed method for extracting building roof contours from digital imagery.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)UNESP FCTUNESP FCT Departamento de CartografiaUNESP FCTUNESP FCT Departamento de Cartografi

In vivo pharmacological evaluations of novel olanzapine analogues in rats: a potential new avenue for the treatment of schizophrenia

Olanzapine (Olz) is one of the most effective antipsychotic drugs commonly used for treating schizophrenia. Unfortunately, Olz administration is associated with severe weight gain and metabolic disturbances. Both patients and clinicians are highly interested in the development of new antipsychotics which are as effective as atypical antipsychotics but which have a lower propensity to induce metabolic side effects. In the present study, we examined two new derivatives of Olz; OlzEt (2-ethyl-4-(4′-methylpiperazin-1′-yl)-10Hbenzo[b]thieno[2,3-e][1,4]diazepine), and OlzHomo (2-ethyl-4-(4′-methyl-1′,4′-diazepan-1′-yl)-10H-benzo[b]thieno[2,3-e] [1,4]diazepine), for their tendency to induce weight gain in rats. Weight gain and metabolic changes were measured in female Sprague Dawley rats. Animals were treated orally with Olz, OlzEt, OlzHomo (3 or 6 mg/kg/day), or vehicle (n = 8), three times daily at eight-hour intervals for 5 weeks. Furthermore, a phencyclidine (PCP)-treated rat model was used to examine the prevention of PCP-induced hyperlocomotor activity relevant for schizophrenia therapy. Male Sprague Dawley rats were pre-treated with a single dose (3 mg/kg/day) of Olz, OlzEt, OlzHomo, or vehicle (n = 12), for 2 weeks. Locomotor activity was recorded following a subcutaneous injection with either saline or PCP (10 mg/kg). Olz was found to induce weight gain, hyperphagia, visceral fat accumulation, and metabolic changes associated with reduced histamatergic H1 receptor density in the hypothalamus of treated rats. In contrast, OlzEt and OlzHomo presented promising antipsychotic effects, which did not induce weight gain or fat deposition in the treated animals. Behavioural analysis showed OlzEt to attenuate PCP-induced hyperactivity to a level similar to that of Olz; however, OlzHomo showed a lower propensity to inhibit these stereotyped behaviours. Our data suggest that the therapeutic effectiveness of OlzHomo may be delivered at a higher dose than that of Olz and OlzEt. Overall, OlzEt and OlzHomo may offer a better pharmacological profile than Olz for treating patients with schizophrenia. Clinical trials are needed to test this hypothesis