Adherence to institutional stroke alert criteria in an academic adult emergency department population.

Background: Timely recognition of acute ischemic stroke (AIS) is essential to identify patients who may be eligible for acute intervention. Protocols to streamline systems-based care, such as "stroke alerts" in the emergency department (ED) can safely reduce time-to-care while enhancing safety. However, clinician adherence to stroke alert criteria is poorly described.

Residual neuromuscular block in the postanaesthesia care unit: a single-centre prospective observational study and systematic review.

Background: Concerns regarding residual neuromuscular block (RNMB) have persisted since the introduction of neuromuscular blocking agents, with reported incidences in the 21st century up to 50%. Advances in neuromuscular transmission (NMT) monitoring and the introduction of sugammadex have addressed this issue, but the impact of these developments remains unclear.

Methods: This prospective observational study evaluated RNMB in 500 surgical patients in a large Dutch teaching hospital with readily available quantitative NMT monitoring and reversal agents.

Triple Anesthesia: Combining Sevoflurane, Propofol, and Remimazolam for General Anesthesia in a Case Series.

There is an ongoing quest for an uniform anesthesia regimen that adequately covers all nociceptive stimuli preventing hypertension and tachycardia while minimizing hypotension and the need for antihypotensive drugs. Recently, the ultra-short-acting benzodiazepine remimazolam was approved for the induction and maintenance of general anesthesia. Combining remimazolam with sevoflurane and propofol may combine the antiemetic properties of propofol, the depressing (immobilizing) effect on spinal motor neurons of sevoflurane, and the hemodynamic stability afforded by remimazolam, making it an attractive addition to the armamentarium of anesthetic agents.

Topical Anaesthesia Using a Soft Mist Spray Device Allows Comfortable Awake Visualisation of the Airway via Self-Videolaryngoscopy in Volunteers.

: During endotracheal intubation, there is a 10% incidence of difficult laryngoscopy, which may result in serious complications. It is important to obtain as much information about the visibility of laryngeal structures before the patient is anaesthetised. Performing awake (video-) laryngoscopy on a patient is uncomfortable and can trigger gagging and coughing reflexes, making visualisation nearly impossible.

Photoplethysmography upon cold stress-impact of measurement site and acquisition mode.

Photoplethysmography (PPG) allows various statements about the physiological state. It supports multiple recording setups, i.e.

Absolute Configuration Determination of Chiral API Molecules by MicroED Analysis of Cocrystal Powders Formed Based on Cocrystal Propensity Prediction Calculations.

Establishing the absolute configuration of chiral active pharmaceutical ingredients (APIs) is of great importance. Single crystal X-ray diffraction (scXRD) has traditionally been the method of choice for such analysis, but scXRD requires the growth of large crystals, which can be challenging. Here, we present a method for determining absolute configuration that does not rely on the growth of large crystals.

Temporal trends in the incidence of malignancy in heart failure: a nationwide Danish study.

Aims: Cancer and heart failure (HF) share risk factors, pathophysiological mechanisms, and possibly genetics. Improved HF survival may increase the risk of cancer due to a competing risk. Whether the incidence of cancer has increased over time in patients with HF as survival has improved is unclear.

[Transcultural German translation of the reflux symptom score-12 questionnaire].

In addition to clinical and instrumental methods as well as medical history, questionnaires are well-established tools in the diagnosis of laryngopharyngeal reflux (LPR). Recently, the reflux symptom score (RSS) as well as the short version of it, the RSS-12, which are self-administered patient-reported outcome questionnaires, have been published as an alternative to the well-established reflux symptom index (RSI). The RSS-12 assesses severity and frequency of LPR symptoms as well as the impact on quality of life and has been shown to have high reliability and validity.

Adherence and Discontinuation of Optimal Heart Failure Therapies According to Age: A Danish Nationwide Study.

Background Guideline-recommended disease-modifying pharmacological therapies for heart failure (HF) with reduced ejection fraction are underutilized, particularly among elderly patients. We studied the association of age in adherence and discontinuation of angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers (ACEi/ARB), β-blockers (BB), and mineralocorticoid receptor antagonists. Methods and Results Patients with a first heart failure diagnosis who had initiated ACEi/ARB and BB within 120 days of presentation were included from nationwide registries and divided into 3 age groups: <65 years (reference), 65 to 79, and ≥80.

Temporal trends in major cardiovascular events following first-time myocardial infarction in the reperfusion era - a Danish nationwide cohort study from 2000 to 2017.

Aim: We investigated temporal trends in major cardiovascular events following first-time myocardial infarction (MI) and trends in revascularization and pharmacotherapy from 2000 to 2017.

Methods And Results: Using nationwide registries, we identified 120 833 Danish patients with a first-time MI between 2000 and 2017. We investigated 30-day and 1-year mortality and the 1-year risk of first-time admission for heart failure (HF) and recurrent MI.

Informed Consent Practices in Global Surgery among Plastic Surgery Organizations.

Background: Global surgery organizations often serve vulnerable and complex patient populations, but there is limited knowledge on the protocols used to obtain informed consent for procedures and content sharing.

Methods: The Plastic Surgery Foundation Volunteers in Plastic Surgery database was queried for organizations actively involved in global surgery. Seventy-nine organizations received email invitations to participate in a survey study regarding their protocols for obtaining consent for procedures and sharing multimedia content.

Cryo-EM structure of the HIV-1 Pol polyprotein provides insights into virion maturation.

Key proteins of retroviruses and other RNA viruses are translated and subsequently processed from polyprotein precursors by the viral protease (PR). Processing of the HIV Gag-Pol polyprotein yields the HIV structural proteins and enzymes. Structures of the mature enzymes PR, reverse transcriptase (RT), and integrase (IN) aided understanding of catalysis and design of antiretrovirals, but knowledge of the Pol precursor architecture and function before PR cleavage is limited.

From Powders to Single Crystals: A Crystallographer's Toolbox for Small-Molecule Structure Determination.

Although the crystal structures of small-molecule compounds are often determined from single-crystal X-ray diffraction (scXRD), recent advances in three-dimensional electron diffraction (3DED) and crystal structure prediction (CSP) methods promise to expand the structure elucidation toolbox available to the crystallographer. Herein, a comparative assessment of scXRD, 3DED, and CSP in combination with powder X-ray diffraction is carried out on two former drug candidate compounds and a multicomponent crystal of a key building block in the synthesis of gefapixant citrate.

Absolute configuration determination of pharmaceutical crystalline powders by MicroED chiral salt formation.

Microcrystal electron diffraction (MicroED) has established its complementary role alongside X-ray diffraction in crystal structure elucidation. Unfortunately, kinematical refinement of MicroED data lacks the differentiation power to assign the absolute structure solely based on the measured intensities. Here we report a method for absolute configuration determination MicroED by employing salt formation with chiral counterions.

Postoperative pain reduction by pre-emptive N-acetylcysteine: an exploratory randomized controlled clinical trial.

Background: A new potential target for multimodal pain management is the group-II metabotropic glutamate receptor subtypes, which can be activated by N-acetylcysteine. We investigated whether pre-emptive administration of N-acetylcysteine leads to a reduction in postoperative pain after laparoscopic inguinal hernia repair.

Methods: Sixty American Society of Anesthesiologists I-II patients scheduled for elective inguinal hernia repair were randomized to receive either N-acetylcysteine (150 mg/kg) or placebo intravenously 1 hour before surgery.

Small Molecule Microcrystal Electron Diffraction for the Pharmaceutical Industry-Lessons Learned From Examining Over Fifty Samples.

The emerging field of microcrystal electron diffraction (MicroED) is of great interest to industrial researchers working in the drug discovery and drug development space. The promise of being able to routinely solve high-resolution crystal structures without the need to grow large crystals is very appealing. Despite MicroED's exciting potential, adoption across the pharmaceutical industry has been slow, primarily owing to a lack of access to specialized equipment and expertise.

Convergence of a common solution for broad ebolavirus neutralization by glycan cap-directed human antibodies.

Antibodies that target the glycan cap epitope on the ebolavirus glycoprotein (GP) are common in the adaptive response of survivors. A subset is known to be broadly neutralizing, but the details of their epitopes and basis for neutralization are not well understood. Here, we present cryoelectron microscopy (cryo-EM) structures of diverse glycan cap antibodies that variably synergize with GP base-binding antibodies.

Comparative in-vitro Study of the Trachospray, a New Device for Topical Anaesthesia of the Upper Airway.

Background: Obtaining complete topical anaesthesia of the airway remains a clinical challenge. Particle size is one of the most important variables for the dose deposited and the distribution of aerosols in the airways. The mass median aerodynamic diameter of the particles should be in the range of 5-20 µm.

Leginon: New features and applications.

Leginon is a system for automated data acquisition from a transmission electron microscope. Here we provide an updated summary of the overall Leginon architecture and an update of the current state of the package. We also highlight a few recent developments to provide some concrete examples and use cases.

Ethnopharmacology - A journal, a definition and a society.

Ethnopharmacological Relevance: Historical development of the Journal of Ethnopharmacology, the International Society of Ethnopharmacology, and the first definition of ethnopharmacology.

Aim Of The Study: To present the background to, and the people involved, in the foundation of the journal and the society.

Materials And Methods: Personal recollections, archival documents and photographs.

Clonal evolution and genome stability in a 2500-year-old fungal individual.

Individuals of the basidiomycete fungus Armillaria are well known for their ability to spread from woody substrate to substrate on the forest floor through the growth of rhizomorphs. Here, we made 248 collections of A. gallica in one locality in Michigan's Upper Peninsula.