Restrictive versus high-dose oxygenation strategy in post-arrest management following adult non-traumatic cardiac arrest: a meta-analysis.

PURPOSE: Neurological damage is the main cause of death or withdrawal of care in comatose survivors of cardiac arrest (CA). Hypoxemia and hyperoxemia following CA were described as potentially harmful, but reports were inconsistent. Current guidelines lack specific oxygen targets after return of spontaneous circulation (ROSC). OBJECTIVES: The current meta-analysis assessed the effects of restrictive compared to high-dose oxygenation strategy in survivors of CA. METHODS: A structured literature search was performed. Randomized controlled trials (RCTs) comparing two competing oxygenation strategies in post-ROSC management after CA were eligible. The primary end point was short-term survival (≤ 90 days). The meta-analysis was prospectively registered in PROSPERO database (CRD42023444513). RESULTS: Eight RCTs enrolling 1941 patients were eligible. Restrictive oxygenation was applied to 964 patients, high-dose regimens were used in 977 participants. Short-term survival rate was 55.7% in restrictive and 56% in high-dose oxygenation group (8 trials, RR 0.99, 95% CI 0.90 to 1.10, P = 0.90, I2 = 18%, no difference). No evidence for a difference was detected in survival to hospital discharge (5 trials, RR 0.98, 95% CI 0.79 to 1.21, P = 0.84, I2 = 32%). Episodes of hypoxemia more frequently occurred in restrictive oxygenation group (4 trials, RR 2.06, 95% CI 1.47 to 2.89, P = 0.004, I2 = 13%). CONCLUSION: Restrictive and high-dose oxygenation strategy following CA did not result in differences in short-term or in-hospital survival. Restrictive oxygenation strategy may increase episodes of hypoxemia, even with restrictive oxygenation targets exceeding intended saturation levels, but the clinical relevance is unknown. There is still a wide gap in the evidence of optimized oxygenation in post-ROSC management and specific targets cannot be concluded from the current evidence.

Research Note: Validation of a low-cost accelerometer to measure physical activity in 30 to 32-d-old male Ross 708 broilers.

Poultry activity measurements are often associated with expensive equipment or time-consuming behavior observations. Since low-cost accelerometers are available, the current study validated the FitBark (FitBark 2, FitBark Inc., Kansas City, MO) accelerometer for use on 30 to 32-d-old male Ross 708 broilers. The FitBark provides aggregated activity levels based on tri-axial accelerometer technology. Broilers were housed in 5 rooms, each divided into 12 2 × 2.3 m pens (60 birds per pen, 31 kg m-2 final density). From 30 to 32 d, 1 broiler per room (n = 5) was randomly selected and equipped with a 13 g FitBark. Elastic loops were placed around the wings to secure the FitBark medially on the back. During the same time, validity was assessed via ceiling-mounted video cameras. The video recordings were analyzed using 20-min continuous sampling during the photo phase at 8 time periods per bird. Behavior was assessed every second using an ethogram (9,600 data points per bird). In the first step, the FitBark data were matched and correlated with the corresponding video-based observed activity (OA) data. The FitBark and OA data were not normally distributed (1-sample KS test, all n = 800, ZFitBark = 0.21, ZOA = 0.24, all P < 0.001). Therefore, data were transformed, and a repeated measures correlation was performed for each bird, showing a positive correlation between the FitBark and OA data (rrm = 0.76, 95% CI = 0.72-0.78, df = 794, P < 0.001). In the second step, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. The FitBark correctly identified 91% (sensitivity) of the active and 74% (specificity) of the inactive birds. When the FitBark detected an active or inactive bird, there was a probability of 89% (PPV) and 78% (NPV) that the bird was observed to be active or inactive based on the OA data. Accuracy was at 86%. Overall, FitBark are useful for 1-min interval activity measurements in 30 to 32-d-old male Ross 708 broilers. Further research should focus on validating the FitBark at other ages and in different poultry species.

Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndrome: a meta-analysis.

BACKGROUND: Percutaneous coronary intervention (PCI) is standard of care in patients with acute coronary syndrome (ACS) suitable for interventional revascularization. Intracoronary imaging by optical coherence tomography (OCT) expanded treatment approaches adding diagnostic information and contributing to stent optimization. OBJECTIVES: This meta-analysis aimed to assess the effects of OCT-guided vs. angiography-guided PCI in treatment of ACS. METHODS: A structured literature search was performed. All controlled trials evaluating OCT-guided vs. angiography-guided PCI in patients with ACS were eligible. The primary end point was major adverse cardiac events (MACE). RESULTS: Eight studies enrolling 2612 patients with ACS were eligible. 1263 patients underwent OCT-guided and 1,349 patients angiography-guided PCI. OCT guidance was associated with a 30% lower likelihood of MACE (OR 0.70, 95% CI 0.53-0.93, p = 0.01, I2 = 1%). OCT-guided PCI was also associated with significantly decreased cardiac mortality (OR 0.49, 95% CI 0.25-0.96, p = 0.04, I2 = 0%). There was no detectable difference in all-cause mortality (OR 1.08, 95% CI 0.51-2.31, p = 0.83, I2 = 0). Patients in OCT-guided group less frequently required target lesion revascularization (OR 0.26, 95% CI 0.07-0.95, p = 0.04, I2 = 0%). Analysis of myocardial infarction did not result in significant treatment differences. In subgroup or sensitivity analysis the observed advantages of OCT-guided PCI were not replicable. CONCLUSION: The evidence suggests that PCI guidance with OCT in ACS decreases MACE, cardiac death and target lesion revascularization compared to angiography. On individual study level, in subgroup or sensitivity analyses these advantages were not thoroughly replicable.

Fibre-based feed supplements - fermentation and moisture characteristics, edibility and particle size influence cage-reared laying hens' preference based on feed consumption and time at the feeder.

1. Past studies have shown that fibre-based feed supplements, such as silage, are well accepted by laying hens and can reduce feather pecking and cannibalism. What is uncertain is whether fermentation and moisture characteristics, edibility or particle size influence the hen's choice for a fibre-based feed supplement or if there are more preferred materials.2. The study included three experiments on fermentation and moisture characteristics (Experiment 1), edibility (consumable; Experiment 2) and particle size (Experiment 3) on laying hen preference for different supplements.3. Experiments were conducted in conventional cages, where two cages formed one replication (six replicates per treatment) and each feeding area was subdivided into a trough (basal diet) and a supplement insert (supplements). Since the hens had a free choice between the basal diet and the supplements, feed consumption and the percentage of time hens spent at the supplement insert indicated the strength of preference. The basal diet dry matter (DM) consumption was assessed for all experiments and the supplement and total DM consumption was documented for Experiments 1 and 3. In addition, the percentage of the observed time hens spent at the trough or supplement insert was observed for Experiments 2 and 3.4. There was an increase in the supplement DM consumption for non-fermented and moist supplements (P < 0.05) and, in some cases, a smaller particle size (P < 0.05). Furthermore, hens spent more time with edible (P < 0.05) and small-sized (P < 0.05) supplements. It was concluded that a preferred material in addition to the basal diet could increase the time hens spend at the feeder by up to 1 hour per photoperiod.

Impact of respiratory infectious epidemics on STEMI incidence and care.

The effect of respiratory infectious diseases on STEMI incidence, but also STEMI care is not well understood. The Influenza 2017/2018 epidemic and the COVID-19 pandemic were chosen as observational periods to investigate the effect of respiratory virus diseases on these outcomes in a metropolitan area with an established STEMI network. We analyzed data on incidence and care during the COVID-19 pandemic, Influenza 2017/2018 epidemic and corresponding seasonal control periods. Three comparisons were performed: (1) COVID-19 pandemic group versus pandemic control group, (2) COVID-19 pandemic group versus Influenza 2017/2018 epidemic group and (3) Influenza 2017/2018 epidemic group versus epidemic control group. We used Student's t-test, Fisher's exact test and Chi square test for statistical analysis. 1455 patients were eligible. The daily STEMI incidence was 1.49 during the COVID-19 pandemic, 1.40 for the pandemic season control period, 1.22 during the Influenza 2017/2018 epidemic and 1.28 during the epidemic season control group. Median symptom-to-contact time was 180 min during the COVID-19 pandemic. In the pandemic season control group it was 90 min (p = 0.183), and in the Influenza 2017/2018 cohort it was 90 min, too (p = 0.216). Interval in the epidemic control group was 79 min (p = 0.733). The COVID-19 group had a door-to-balloon time of 49 min, corresponding intervals were 39 min for the pandemic season group (p = 0.038), 37 min for the Influenza 2017/2018 group (p = 0.421), and 38 min for the epidemic season control group (p = 0.429). In-hospital mortality was 6.1% for the COVID-19 group, 5.9% for the Influenza 2017/2018 group (p = 1.0), 11% and 11.2% for the season control groups. The respiratory virus diseases neither resulted in an overall treatment delay, nor did they cause an increase in STEMI mortality or incidence. The registry analysis demonstrated a prolonged door-to-balloon time during the COVID-19 pandemic.

Erratum: Azimuthal Anisotropy of K_{S}

This corrects the article DOI: 10.1103/PhysRevLett.89.132301.

Erratum: Azimuthal Anisotropy at the Relativistic Heavy Ion Collider: The First and Fourth Harmonics [Phys. Rev. Lett. 92, 062301 (2004)].

This corrects the article DOI: 10.1103/PhysRevLett.92.062301.

[Prioritization of intensive medical treatment places - Concept proposal]. / Priorisierung intensivmedizinischer Behandlungsplätze ­ Konzeptvorschlag.

In the situation of a shortage of ventilation beds, ethically justifiable, transparent and comprehensible decisions must be made. This concept proposes that all patients are first intubated depending on necessity and then assessed by a triage team afterwards. In this situation newly admitted COVID patients compete with newly admitted Non-COVID patients as well as patients already treated in intensive care units for a ventilator. The combination of short-term and long-term prognoses should enable the interprofessional triage team to make comprehensible decisions. The aim of the prioritization concept is to save as many human lives as possible and to relieve the treatment team of the difficult decision on prioritization.

Midterm outcomes of LAA occlusion with the AMPLATZER Cardiac Plug and AMPLATZER Amulet devices in a high-risk cohort.

LAA occlusion has become a favourable option in patients with atrial fibrillation not eligible for oral anticoagulation therapy. Proof of effectiveness of LAA closure devices in a midterm follow-up period. This retrospective single-center cohort study analysed outcome in patients treated with AMPLATZER Cardiac Plug or AMPLATZER Amulet device. A standardized follow-up by phone call focusing on data of death, stroke and bleeding events was performed. Routine antiplatelet strategy was DAPT for 3 months post procedural. 212 patients (mean age 77 ± 6 years) were included. Follow up was performed in 197 (93%) patients. Patients were at high risk for thromboembolic or bleeding events (prior stroke/TIA 29%; prior bleeding 54%. Overall, there was a mean follow-up period of 1244.2 days (± 756.7) and a total of 674 patient years. We observed 25 events later than day 8 post procedure. We were able to demonstrate a high effectiveness of the AMPLATZER Cardiac Plug/AMPLATZER Amulet devices regarding the prevention of stroke and bleedings in a high-risk real-world cohort during a midterm follow-up period. Overall, we observed remarkably lower rates of stroke and bleedings as predicted with CHA2DS2-VASc and HASBLED scores.

Effects of a partially perforated flooring system on animal-based welfare indicators in broiler housing.

Alternative flooring designs in broiler housing have been the subject of intensive research. Research comparing different floor types with a focus on animal-based welfare indicators might be of special interest to meet the animal's needs. This case-control study investigated the effect of a partially perforated vs. a littered flooring system on health- and behavior-based welfare indicators of fast-growing Ross 308 broilers. Furthermore, production performance was assessed. The experimental barn was partially (50%) equipped with a perforated floor directly underneath the feeders and water lines accessible by perforated ramps. Conventional wood shavings were used in the control barn, as usual in practice. There were 4 fattening periods (repetitions) of 31 to 32 D performed with 500 animals per barn (final density of 39 kg m-2). Beside the flooring system, management conditions were identical. Health- and behavior-based welfare indicators were assessed weekly. Production performance indicators were measured continuously during animal control. During the avoidance distance test, animals were less fearful on day 21 (P = 0.010) and tended to be less fearful on day 28 (P = 0.083) in the barn with the partially perforated flooring system compared to the littered control barn. More animals around the novel object were also assessed in the barn with the partially perforated flooring system during the novel object test on day 1 (P < 0.001) and a tendency was found on day 28 (P = 0.064). Results showed that the partially perforated flooring system had a positive influence on foot pad dermatitis from day 14 (all P ≤ 0.007) and hock burn on day 28 (P < 0.001). With regard to the production performance, animals showed no differences in final body weight for both floor types. In this study, the partially perforated flooring system had a positive effect on animal health and behavior as indicated by welfare indicators without a reduction in production performance.

Pseudomonas stutzeri MJL19, a rhizosphere-colonizing bacterium that promotes plant growth under saline stress.

AIMS: The aim of this study was to find and use rhizobacteria able to confer plants advantages to deal with saline conditions. METHODS AND RESULTS: We isolated 24 different bacterial species from the rhizosphere of halophyte plants growing in Santiago del Estero, Argentina salt flat. Four strains were selected upon their ability to grow in salinity and their biochemical traits associated with plant growth promotion. Next, we tested the adhesion on soybean seeds surface and root colonization with the four selected isolates. Isolate 19 stood out from the rest and was selected for further experiments. This strain showed positive chemotaxis towards soybean root exudates and a remarkable ability to form biofilm both in vitro conditions and on soybean roots. Interestingly, this trait was enhanced in high saline conditions, indicating the extremely adapted nature of the bacterium to high salinity. In addition, this strain positively impacted on seed germination, plant growth and general plant health status also under saline stress. CONCLUSIONS: A bacterium isolate with outstanding ability to promote seed germination and plant growth under saline conditions was found. SIGNIFICANCE AND IMPACT OF THE STUDY: The experimental approach allowed us to find a suitable bacterial candidate for a biofertilizer intended to alleviate saline stress on crops. This would allow the use of soil now considered inadequate for agriculture and thus prevent further advancement of agriculture frontiers into areas of environmental value.

Think before you prescribe: how dentistry contributes to antibiotic resistance.

Antibiotic resistance presents a daunting challenge to health professionals worldwide and has the potential to create major problems for modern health care, resulting in more medical expenditure, extended hospital stays and increased morbidity and mortality. Advanced genome sequencing technologies present a complex picture of resistance, extending our understanding beyond the pharmacotherapeutic interface between pathogens and antibiotics. This review discusses the global scope and scale of antibiotic resistance and contextualizes it for the dental practitioner, emphasizing the role we must play in limiting the progression of resistance through antibiotic stewardship and disease prevention.

[Emergency management in the heart catheter laboratory : When intensive care physicians meet cardiologists]. / Notfallmanagement im Herzkatheterlabor : Wenn Intensivmediziner und Kardiologen zusammentreffen.

The establishment of primary percutaneous interventions for the treatment of myocardial infarction, increasingly complex coronary and noncoronary interventions in severely ill patients, and the increasing rise in the number of catheter examinations in elderly and morbid patients due to demographics frequently necessitates involvement of intensive care physicians for primary care of unstable patients and management of complications within the cath lab. In the context of complication and risk management, therefore, all cardiac catheter labs should develop a checklist in collaboration with the respective emergency/intensive care team. Team-oriented interdisciplinary management through standardization of emergency scenarios remains the key to success, despite all progress.

[Which patients benefit from transport with ongoing cardiopulmonary resuscitation? : Retrospective analysis of 70 patients with refractory preclinical cardiac arrest]. / Welcher Patient profitiert von einem Transport unter laufender kardiopulmonaler Reanimation? : Retrospektive Analyse von 70 Patienten mit refraktärem präklinischem Herzstillstand.

BACKGROUND: Mortality in patients with out-of-hospital cardiac arrest (OHCA) remains very high despite advances in resuscitation algorithms. Most of these patients die at the scene and do not reach hospital. It is currently the subject of discussion whether transport to hospital with ongoing cardiopulmonary resuscitation (CPR) improves survival and neurological outcome in patients with OHCA. OBJECTIVE: The aim of this study was to identify predictors of survival and good neurological outcome in patients after OHCA who were transported to hospital with ongoing CPR. PATIENTS AND METHODS: A total of 70 consecutive patients with refractory OHCA (mean age 54.7 ± 15 years) transported to hospital with ongoing CPR were retrospectively analyzed. Neurological outcome was assessed after 30 days based on the Glasgow-Pittsburgh cerebral performance category (CPC). RESULTS: After 30 days 82.9% of the patients enrolled in the trial died (CPC score of 5), 8 patients (11.4%) showed a good neurological recovery with CPC scores of 1-2 and 4 patients (5.7%) had a poor neurological outcome with CPC scores of 3-4. Predictors of good neurological outcome were witnessed arrest, initial defibrillatable rhythm and serum lactate levels on admission. In all patients with good outcome, the index event for OHCA was from cardiac causes. CONCLUSION: Selected patient collectives can benefit from transport to hospital with ongoing cardiopulmonary resuscitation (CPR).

[Rapid progress of a cerebral edema due to fulminant hyponatremia]. / Rapide Entwicklung eines Hirnödems infolge einer fulminanten Hyponatriämie.

Severe acute hyponatremia is a life-threatening illness. We report the case of a 38-year-old woman with lethal cerebral edema due to acute isovolemic hyponatremia.

GBA mutations in Parkinson disease: earlier death but similar neuropathological features.

BACKGROUND AND PURPOSE: Mutations in the glucocerebrosidase (GBA) gene are known to be a risk factor for Parkinson's disease (PD). Data on clinicopathological correlation are limited. The purpose of this study was to determine the clinicopathological findings that might distinguish PD cases with and without mutations in the GBA gene. METHODS: Data from the Arizona Study of Aging and Neurodegenerative Disorders were used to identify autopsied PD cases that did or did not have a GBA gene mutation. Clinical and neuropathological data were compared. RESULTS: Twelve PD cases had a GBA mutation and 102 did not. The GBA mutation cases died younger (76 vs. 81 years of age) but there was no difference in disease duration or clinical examination findings. No neuropathological differences were found in total or regional semi-quantitative scores for Lewy-type synucleinopathy, senile plaques, neurofibrillary tangles, white matter rarefaction or cerebral amyloid angiopathy scores. CONCLUSIONS: In longitudinally assessed, autopsied PD cases, those with GBA mutations had a younger age at death but there was no evidence for clinical or neuropathological differences compared to cases without GBA mutations. Due to the small GBA group size, small differences cannot be excluded.