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Difficult airway in children with trisomy 18: prevalence, outcomes, and complications in a single center retrospective observational study Introduction: Trisomy 18 (T18) is the second most common autosomal trisomy disorder after Down syndrome, with a prevalence of 1/6000-8000(1). It is characterized by multiple congenital malformations including craniofacial anomalies, congenital heart disease, multilevel airway obstruction, gastrointestinal and genitourinary defects, orthopedic anomalies, and severe neurocognitive disability. Airway management of children withT18 can be challenging due to characteristic craniofacial features(2)(3). This study examined the frequency of difficult airway including difficult mask ventilation and difficult intubation, adverse events of airway management, and related outcomes in a large children’s hospital. Methods: We performed a retrospective medical record review of children 0.2 considered unbalanced distribution. Results: Of 165 anesthetics from 48 children, the adjusted prevalence of difficult mask ventilation was 2.9% (95% confidence interval [CI] (0.92%- 7.61%), 4/140), the prevalence of difficult intubation was 41.4% (95% CI (33.4%- 49.9%), 60/145), and the prevalence of difficult airway among airway interventions was 36.4% (95% CI (29.1%- 44.3%), 60/165). Among difficult intubations performed by anesthesiologists, video laryngoscope (VL) was utilized in 48.3% and a fiberoptic (FOI) -only or combined technique used in 15%; 21.7% of intubations were performed by an otolaryngologist who most often used the rigid bronchoscope (70%). Difficult intubation was most likely in infants (55%, SD 0.35), and children ≤ 10kg (78%, SD 0.77). Difficult intubation also was more common during otolaryngology procedures (45%) and when the child had an anatomical feature known to be associated with difficult intubation (67%, SD 0.61). Hypoxemia occurred in 45.5% of airway interventions. Critical cardiopulmonary events requiring treatment with at least one vasoactive medication occurred in 7% of inductions. Discussion: Difficult airway and difficult intubation were common in children with T18, especially in those with micrognathia/ retrognathia, young age or weight ≤10kg, and undergoing otolaryngology procedures. Difficult intubations were frequently managed using non-conventional airway devices. Conclusion: Children with T18 require special perioperative care for a potential difficult airway. References 1. Mai CT, et al. Birth Defects Res A Clin Mol Teratol. 2015;103(11):972-93. 2. Bansal T, et al. Egypt J Anaesth. 2016;32(2):227-+. 3. Birmingham EE, et al. Paediatr Anaesth. 2021;31(4):419-28.

The soil quality index (SQI) is based on several key indicators and is used to assess soil quality. More than 250,000 ha of walnut saplings (Juglans regia L.) were planted in previous cropland areas in the Sichuan Basin, China, using a range of soil cover types that may affect soil quality with effects that are unclear. We investigated the effects of white film (WF), black film (BF), shade netting (SN), and maize straw (MS) soil cover types and an uncovered control type (CK) on soil chemical and biological indicators and the SQI in the 0-15 cm soil layer in a young walnut forest in the Sichuan Basin over a 27-month study period. The results showed that all soil cover types increased the soil organic matter (SOM), total potassium (TK), and available potassium (AK) concentrations (p &lt, 0.05), whereas the total nitrogen (TN) and available nitrogen (AN) concentrations were greater only in soils covered by MS than in CK (p &lt, 0.05). The available phosphorus concentrations were 64.1 and 193.2% greater in soils covered by BF and MS treatments, respectively, than in the CK (p &lt, 0.05). The numbers of soil faunal groups (N) were 45.7, 36.4, 37.2, and 101.5% higher in WF, BF, SN, and MS, respectively, than in CK (p &lt, 0.05), the individual numbers (S) were 92.3, 36.2, 100.8, and 154.5% greater in WF, BF, SN, and MS, respectively, than in CK (p &lt, 0.05). The microbial biomass carbon (MBC) was 15.5, 32.3, 45.0, and 77.1% greater in WF, BF, SN, and MS than in CK, respectively (p &lt, 0.05). Redundancy discriminant analysis revealed strong positive interactions between biological indicators (MBC, N, and S) and SOM, AN, and AK concentrations. SOM, TN, AK, S, and MBC were the minimum required variables for the effective assessment of the SQI. All four soil cover types led to an improved SQI (p &lt, 0.05), and MS had the greatest effect on SOM, TN, AN, AP, N, S, MBC, and SQI (p &lt, 0.05). In conclusion, all four soil cover types increased the SOM levels, TK, AK, and MBC concentrations, soil faunal diversity, and SQI. The MS treatment was the most cost-effective and efficient measure to improve soil fertility, ecological function, and overall soil quality in the studied walnut forest.

To investigate the dynamic responses of high-speed motor-gear transmission system in the electric vehicle, the non-linear coupled lateral-torsional-axial vibration model of motor-gear-rotor coupling system is developed based on the engagement of gears under various excitations. Firstly, the electromagnetic radial and tangential forces of the permanent magnetic synchronous machine are analyzed by finite element method, and the influences of the extracted electromagnetic radial and tangential force with considering the slot effect and magnetic ...