Randomized equivalence trial of the King Vision aBlade videolaryngoscope with the Miller direct laryngoscope for routine tracheal intubation in children <2 yr of age.

BACKGROUND.: We conducted a randomized equivalence trial to compare direct laryngoscopy using a Miller blade (DL) with the King Vision videolaryngoscope (KVL) for routine tracheal intubation. We hypothesized that tracheal intubation times with DL would be equivalent to the KVL in children <2 yr of age. METHODS.: Two hundred children were randomly assigned to tracheal intubation using DL or KVL. The primary outcome was the median difference in the total time for successful tracheal intubation. Secondary outcomes assessed were tracheal intubation attempts, time to best glottic view, time for tracheal tube entry, percentage of glottic opening score, airway manoeuvres needed, and complications. RESULTS.: The median difference between the groups was 5.7 s, with an upper 95% confidence interval of 7.5 s, which was less than our defined equivalence time difference of 10 s. There were no differences in the number of tracheal intubation attempts and the time to best glottic view [DL median 5.3 (4.1-7.6) s vs KVL 5.0 (4.0-6.3) s; P =0.19]. The percentage of glottic opening score was better when using the KVL [median 100 (100-100) vs DL median 100 (90-100); P <0.0001]. Use of DL was associated with greater need for airway manoeuvres during tracheal intubation (33 vs 7%; P <0.001). Complications did not differ between devices. CONCLUSIONS.: In children <2 yr of age, the KVL was associated with equivalent times for routine tracheal intubation when compared with the Miller blade. CLINICAL TRIAL REGISTRATION: NCT02590237.

Ischaemic stroke prevention in patients with atrial fibrillation and high bleeding risk: opportunities and challenges for percutaneous left atrial appendage occlusion.

Patients with atrial fibrillation (AF) are at an increased risk of ischaemic stroke. The efficacy of stroke prevention with vitamin K antagonists in these patients has been well established. However, associated bleeding risks may offset the therapeutic benefits in patients with risk factors for bleeding. Despite improvements achieved by novel oral anticoagulants, bleeding remains a clinically relevant problem, especially gastrointestinal bleeding. Percutaneous occlusion of the left atrial appendage (LAA) may be considered as an alternative stroke prevention therapy in AF patients with a high bleeding risk. This paper explores patient groups in whom oral anticoagulation may be challenging and percutaneous LAA occlusion (LAAO) has a potentially better risk-benefit balance. The current status of LAAO and future directions are reviewed, and particular challenges for LAA occlusion requiring further clinical data are discussed. This article is a summary of the Third Global Summit on LAA occlusion, 15 March 2013, Barcelona, Spain.

Diabetes incidence does not differ between subjects with and without high depressive symptoms--5-year follow-up results of the Heinz Nixdorf Recall Study.

AIMS: Cross-sectional studies have consistently reported evidence for an association between diabetes and depressive disorders. However, only limited prospective studies have examined this association, reporting conflicting results. In a population-based cohort study, we compared cumulative incidences of diabetes between participants with and without high depressive symptoms. METHOD: We analysed the 5-year follow-up data from the German Heinz Nixdorf Recall study of 3547 participants without diabetes at baseline [mean age 58.8 (sd 7.6) years, 47.5% male]. Depressive symptoms were defined using the Centre for Epidemiologic Studies Depression scale (cut point ≥ 17). Diabetes (diagnosed or previously undetected) was identified by self-reported physician-diagnosed diabetes, medication and high blood glucose levels. We estimated 5-year cumulative incidences with 95% confidence intervals and fitted multiple logistic regression models to calculate the odds ratios, adjusted for age, sex, physical activity, smoking, living with or without partner, and educational level. RESULTS: The cumulative incidence of diabetes was 9.2% (95% CI 6.3-12.8) in participants with high depressive symptoms at baseline and 9.0% (95% CI 8.0-10.0) in participants without these symptoms. The age- and sex-adjusted odds ratio of diabetes in participants with depressive symptoms compared with those without was 1.13 [95% CI 0.77-1.68; fully adjusted 1.11 (95% CI 0.74-1.65)]. These results did not substantially change in several additional sensitivity analyses. CONCLUSION: Our study did not show a significantly increased risk of developing diabetes in individuals with high depressive symptoms compared with those without high depressive symptoms during a 5-year follow-up period.

Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics.

AIMS: Little is known about the incidence of paroxysmal atrial tachycardias (PAT) in patients with heart failure (HF). The availability of cardiac resynchronization therapy (CRT) devices with extended diagnostics for AT enables continuous monitoring of PAT episodes. The aim of the study was to assess the incidence over time of PAT in HF patients treated with CRT. METHODS AND RESULTS: Consecutive patients in NYHA functional class III or IV despite optimal drug therapy, QRS duration > or = 130 ms, left ventricular ejection fraction < or = 35%, and left ventricular end-diastolic dimension > or = 55 mm were eligible for enrolment. Patients with permanent or persistent atrial fibrillation (AF) were not included in the study. The first follow-up examination was performed 2 weeks after implantation, to optimize atrial sensing and CRT. Subsequent follow-up examinations were carried out 15 and 28 weeks after implantation, to collect the telemetric data. A total of 173 patients (67 +/- 11 years, M 116) were enrolled. Complete arrhythmia monitoring data were available from 120 patients over a mean follow-up of 183 +/- 23 days. Atrial tachycardia episodes were detected through telemetry in 25 of 120 patients (21%) during at least one follow-up examination. Atrial tachycardia episodes were recorded in 29 and 17% (P = NS) of patients with and without previous history of AF, respectively. CONCLUSION: More than 20% of the overall HF patient population treated with CRT suffer PAT episodes. Paroxysmal atrial tachycardia may interfere with response to CRT. Therefore, telemetric data may be relevant to drive the appropriate therapy in each patient.

Conventional and dedicated atrial overdrive pacing for the prevention of paroxysmal atrial fibrillation: the AFTherapy study.

AIMS: This investigation was conducted to determine the effectiveness of several conventional overdrive pacing modalities (single rate and rate responsive pacing at various lower rates) and of four dedicated preventive pacing algorithms in the suppression of paroxysmal atrial fibrillation (AF). METHOD AND RESULTS: In this multi-centre, randomized trial, 372 patients with drug-refractory paroxysmal AF were enrolled. Patients received a dual-chamber pacing device capable of delivering conventional pacing therapy as well as dedicated AF prevention pacing therapies and to record detailed AF-related diagnostics. The primary endpoint was AF burden, whereas secondary endpoints were time to first AF episode and averaged sinus rhythm duration. During a conventional pacing phase, patients were randomized to single rate or rate-responsive pacing with lower rates of either 70 or 85 min(-1) or to a control group with single rate pacing at 40 min(-1). In the subsequent preventive pacing phase, patients underwent pacing at a lower rate of 70 min(-1) with or without concomitant application of four preventive pacing algorithms. A substantial amount of data was excluded from the analysis because of atrial-sensing artefacts, identified in the device-captured diagnostics. In the conventional pacing phase, no significant differences were found between various lower rates and the control group receiving single rate pacing at 40 min(-1) or between single rate and rate-responsive pacing. Patients receiving preventive pacing with all four therapies enabled had a similar AF burden compared with patients treated with conventional pacing at 70 min(-1) (P = 0.47). CONCLUSIONS: The results do not demonstrate a significant effect of conventional atrial overdrive pacing or preventive pacing therapies. However, the observations provided important information for further consideration with respect to the design and conduct of future studies on the effect of atrial pacing therapies for the reduction of AF.

Soil to plant uptake of fallout 137Cs by plants from boreal areas polluted by industrial emissions from smelters.

To study the impact of industrial pollution on the soil-to-plant uptake of fallout-radiocesium in a boreal forest ecosystem, four study sites were selected at distances of 7, 16, 21 and 28 km from the large copper-nickel smelter at Monchegorsk on the Kola Peninsula (Russia). At each site, soil and selected plant species were sampled from five plots and analysed separately for 137Cs and 40K. The data show that the root-uptake of 137Cs, as characterised by the median aggregated transfer-factor T(ag), decreased significantly (P < 0.05) with decreasing distance from the smelter for the plants Vaccinium myrtillus (from 0.023 to 0.007 m2 kg-1) and Empetrum nigrum (from 0.015 to 0.007 m2 kg-1), but increased for Deschampsia flexuosa (from 0.013 to 0.031 m2 kg-1). For Vaccinium vitis-idaea a significant trend for the T(ag) was not observed. The median 40K activity concentrations in these plants also decreased significantly (P < 0.001) with decreasing distance from the smelter for Vaccinium myrtillus (from approx. 140 to 20 Bq kg-1 dry wt.), Empetrum nigrum (from approx. 90 to 40 Bq kg-1 dry wt.), and also for Deschampsia flexuosa (from approx. 270 to 40 Bq kg-1 dry wt.). For Vaccinium vitis-idaea such a continuous significant trend was not observed. The results for the Cu-Ni polluted soils thus show: (1) that the soil-to-plant transfer of radiocesium can be significantly modified; (2) that these modifications are quite specific; and (3) that modifications of the uptake of potassium do not always correspond to those of radiocesium.

Soil-to-plant and plant-to-cow's milk transfer of radiocaesium in alpine pastures: significance of seasonal variability.

Because our present knowledge on the environmental behaviour of fallout radiocaesium in semi-natural environments is rather limited, the transfer of this radionuclide and of natural 40K, from soil-to-plant as well as from plant-to-cow's milk was investigated for a typical alpine pasture (site P). For comparison, a nearby alpine pasture (site K) not used for cattle grazing was also studied. Small seasonal effects were found for 137Cs in the plants, but they were different for the two pastures. Due to the presence of a large variety of different plant species on the pastures and soil adhesion on the vegetation from trampling cattle, the scattering of the data was very large, and the seasonal effects were observable only because of the large number of samples (N approximately 100) collected. The aggregated soil-to-plant transfer factor of 137Cs was for site P, on average, 0.002 +/- 0.001 m2 kg(-1). The plant-to-milk transfer coefficient was, on average, 0.02 day l(-1). The 137Cs concentration in the milk of the cows varied within the grazing period only between 1.4 and 2.9 Bq l(-1), with a significant maximum in the beginning of August. As a result of soil adhesion due to cattle trampling, significantly higher ash- and 137Cs contents of the plants were observed at site P as compared to site K. Possible consequences of the above observations with respect to a representative sampling design of vegetation and milk are discussed.

A cytophotometric technique for measuring photosynthetic potential of leaves: preliminary research and development.

A novel combined photographic and cytophotometric technique provides information on the physiological state of leaves and a permanent record of each leaf measured in field studies. The method has the ability to determine the distribution of photosynthetic potential within various portions of the leaf and to scale up to the canopy level as well as down to the cellular level. Photographic transparencies are taken in the field, then brought back to the lab to be analyzed cytophotometrically at the investigator's convenience. The image encoded on the film yields an absorption curve that is similar to that of intact leaves with peaks in the blue (450 nm) and red (660 nm) for paper birch. Internal standards of fluorescein and first surface mirrors combined with standardized magnification and illumination (e.g., ring flash) are used to insure precision and accuracy. Two wavelength and plug cytophotometric equations have been modified for use in this technique. Some problems with the two-wavelength method remain, but the usefulness of the plug method for cytophotometry has been expanded through the use of portable leaf area and chlorophyll meters and portable photosynthesis laboratories. Total photosynthetic potential (TPP) is shown to equal leaf area multiplied by the mean optical density of the leaf. With the use of internal standards TPP can be expressed in fluorescein units or adjusted by optical density of the image of the first surface mirror.

[Antibiotic prophylaxis in closed fractures is cost-effective if the possibility of a deep infection decreases through this by 0.25%]. / Antibiotische profylaxe bij gesloten fracturen kosten-effectief als de kans op een diepe infectie erdoor afneemt met 0.25%.

This patient-control study was undertaken to assess the cost-effectiveness of prophylaxis of postoperative infections after surgical treatment of closed fractures. The costs of 16 patients with an infection (8 with deep infections, 8 with superficial infections) were investigated and compared with the costs of 16 similar noninfected patients for the parameters hospital stay, antibiotics and surgery. The data were collected from the trauma department of the University Hospital of the Free University of Amsterdam. There were no substantial extra costs in the group of the 8 patients with superficial wound infection compared with their noninfected controls. The mean extra costs for a deep infection in the other 8 patients were Dfl 35,224.-. Considering these results, antibiotic prophylaxis of postoperative wound infections is cost-effective, if it leads to a decrease of the risk of deep wound infections by about 0.25%.

[Association of diabetes type 2 and depression - behavioural and biological aspects]. / Assoziation von Diabetes Typ 2 und Depressivität.

BACKGROUND AND OBJECTIVE: Type 2 diabetes and depression often appear together. Although health behaviour and risk factors partially explain this association, other potential mechanisms have yet to be elucidated. METHODS: Explorative literature research for reviews on the topic in PubMed. Additional key-word guided research for studies in PubMed and Cochrane Library employing the keywords "diabetes" AND "depression" in combination with identified relevant single aspects (MeSH-terms) for certain neuroendocrine alterations, neuropathological und neurobiochemestric changes as well as the role of antidepressants. RESULTS: There are no satisfying explanatory models for the complex interaction of both diseases concerning behavioural factors and pathophysiological changes. Currently there are only many single aspects of shared or interacting pathophysiology or behaviour conspicuity. CONCLUSION: The objective of this review is to summarize these aspects and their contributions to the interacting pathophysiology of the two diseases.

Medication costs by glucose tolerance stage in younger and older women and men: results from the population-based KORA survey in Germany.

To estimate medication costs in individuals with diagnosed diabetes, undetected diabetes, impaired glucose regulation and normal blood glucose values in a population-based sample by age and sex.Using the KORA F4 follow-up survey, conducted in 2006-2008 (n=2611, age 40-82 years), we identified individuals' glucose tolerance status by means of an oral glucose tolerance test. We assessed all medications taken regularly, calculated age-sex specific medication costs and estimated cost ratios for total, total without antihyperglycemic drugs, and cardiovascular medication, using multiple 2-part regression models.Compared to individuals with normal glucose values, costs were increased in known diabetes, undetected diabetes and impaired glucose regulation, which was more pronounced in participants aged 40-59 years than in those aged 60-82 years (cost ratios for all medications: 40-59 years: 2.85; 95%-confidence interval: 1.78-4.54, 2.00; 1.22-3.29 and 1.53; 1.12-2.09; 60-82 years: 2.04; 1.71-2.43, 1.17; 0.90-1.51 and 1.09; 0.94-1.28). Compared to individuals with diagnosed diabetes, costs were significantly lower among individuals with impaired glucose regulation across all age and sex strata, also when antihyperglycemic medication was excluded (40-59 years: 0.60; 0.36-0.98, 60-82 years: 0.74; 0.60-0.90; men: 0.72; 0.56-0.93; women: 0.72; 0.54-0.96).We could quantify age- and sex-specific medication costs and cost ratios in individuals with diagnosed diabetes, undetected diabetes and impaired glucose regulation compared to those with normal glucose values, using data of a population-based sample, with oral glucose tolerance test-based identification of diabetes states. These results may help to validly estimate cost-effectiveness of screening and early treatment or prevention of diabetes.

[Type 2 diabetes mellitus and depressive symptoms: what is the cause of what? A systematic literature review]. / Diabetes mellitus Typ 2 und Depressivität: Was ist ursächlich für was? Eine systematische Literaturübersicht.

BACKGROUND: Diabetes mellitus type 2 and depressive symptoms are statistically associated. The question is if one of the two diseases is causal for the other. METHODS: Systematic review using Medline and searching for prospective controlled population based observational studies and meta-analysis in English or German language. RESULTS: Patients with type 2 diabetes have a higher incidence of depressive symptoms - compared to patients having no diabetes. And patients with depressive symptoms have a higher incidence of type 2 diabetes; however the findings for the first relation are only weak. DISCUSSION: Knowing about this - even causal - co-morbidity is important in care, including a routine diagnostic approach to find out if the other disease is also present.

Diabetes and incident depression: Is the association mediated or modified by sociodemographic factors or co-morbidities? A systematic review.

OBJECTIVE: Diabetic patients suffer more frequently from depression. Aim was to evaluate sociodemographic parameters and co-morbidities and late complications as potential modifying factors in the occurrence of depression in diabetic individuals. RESEARCH DESIGN AND METHODS: We performed a systematic review, based on established meta-analyses and additional original publications in 2005-2009 in Medline and PsycINFO. We included articles focusing on longitudinal studies which evaluated the appearance of depression in diabetic and non diabetic individuals and further analyzed interactions or separate additional influences of potential modifying factors. RESULTS: 8 eligible studies were identified. 6 studies were population based. Only 3 studies analyzed the interaction between the variables of interest and diabetes on the incidence of depression. Remaining used diverse other methods to control for associated factors. The strongest influence was found for a general measure of co-morbidities but this influence was ambiguous. No significant modifying effect or interaction was found for sociodemographic factors. CONCLUSION: There seems to be a clear need for more research concerning mediating and modifying factors or a more stringent presentation of results in order to identify groups at risk or to identify treatment strategies.

The differentiation-pattern in dependence of the proportion between inducing and induced cells studied on gastrula-ectoderm of Ambystoma mexicanum.

The dependence of the differentiation-pattern of competent amphibian ectoderm on the proportion of inducing and induced material was studied. To do so different masses of LiCl-treated tissue were combined with a constant mass of untreated material. LiCl-treated isolates corresponding in size with the treated portions in the combinations served as controls. The experiments seem to show at least three factors responsible for the differentiation-pattern of the combinations: the number of inducing cells, the number of cells to be induced, and the competence of the ectoderm, which depends on the stage of development.