Journal of the American College of Surgeons
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Improper mechanical ventilation can exacerbate acute lung damage, causing a secondary ventilator-induced lung injury (VILI). We hypothesized that VILI can be reduced by modifying specific components of the ventilation waveform (mechanical breath), and we studied the impact of airway pressure release ventilation (APRV) and controlled mandatory ventilation (CMV) on the lung micro-anatomy (alveoli and conducting airways). The distribution of gas during inspiration and expiration and the strain generated during mechanical ventilation in the micro-anatomy (micro-strain) were calculated. ⋯ In an injured lung, APRV 75% maintained micro-anatomic gas distribution similar to that of the normal lung. The lung protection demonstrated in previous studies using APRV 75% may be due to a more homogeneous distribution of gas at the micro-anatomic level as well as a reduction in conducting airway micro-strain.
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Increases in pregnancy complication rates and use of assisted reproductive technology (ART) have been demonstrated in female urologists and orthopaedic surgeons when compared with the general US population. To determine if childbearing differences exist across specialties, we evaluated female surgeons in all fields, particularly with regard to fertility. ⋯ Female surgeons have first pregnancies later in life, fewer children, and report more issues with infertility. Assisted reproductive technology is implemented more often by female surgeons than the general population. Differences in fertility exist between specialties and warrant additional study.
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Historical Article
Preoperative antibiotic colon preparation: have we had the answer all along?