| 1 | Focus on peripherally inserted central catheters in critically ill patients显示文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care. | Paolo Cotogni Mauro Pittiruti | 2014 | World Journal of Critical Care Medicine2014，3，4： | 52 |
| 2 | 认识CPU的接口显示文摘我们都知道,CPU即中央处理单元,是英文Central Processing Unit的缩写,是整个系统的核心,也是整个系统最高的执行单位。它的作用是负责整个系统指令的执行,数学与逻辑的运算,数据的存储与传送,以及对内对外输入与输出的控制。因为CPU是决定电脑性能的核心部件.以前人们就以它来判定电脑的档次,于是就有了486、586、PII称呼。事实上.生产CPU的不同厂商.都为自己的产品规定了不同的名称。如Intel公司称作奔腾.AMD公司的称作K6等。目前CPU的接口都是针脚式接口.对应到主板上就有相应的插槽类型。CPU接口类型不同.在插孔数、大小、形状都有变化。所以不能互相接插。 | 李国良 | 2005 | 电脑知识与技术(过刊)2005，，6： | 0 |
| 3 | Challenges and reflections on exascale computing显示文摘This paper introduces the development of the exascale (10^18) computing. Though exascalc computing is a hot research direction worldwide, we are facing many challenges in the areas of memory wall, communica- tion wall, reliability wall, power wall and scalability of parallel computing. According to these challenges, some thoughts and strategies are proposed. | Yang Xuejun | 2014 | Engineering Sciences2014，12，3： | 0 |
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