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BACKGROUND: Over the recent years, technological advances of wrist-worn fitness trackers heralded a new era in the continuous monitoring of vital signs. So far, these devices have primarily been used for sports. OBJECTIVE: However, for using these technologies in health care, further validations of the measurement accuracy in hospitalized patients are essential but lacking to date. METHODS: We conducted a prospective validation study with 201 patients after moderate to major surgery in a controlled setting to benchmark the accuracy of heart rate measurements in 4 consumer-grade fitness trackers (Apple Watch 7, Garmin Fenix 6 Pro, Withings ScanWatch, and Fitbit Sense) against the clinical gold standard (electrocardiography). RESULTS: All devices exhibited high correlation (r≥0.95; P<.001) and concordance (rc≥0.94) coefficients, with a relative error as low as mean absolute percentage error <5% based on 1630 valid measurements. We identified confounders significantly biasing the measurement accuracy, although not at clinically relevant levels (mean absolute error<5 beats per minute). CONCLUSIONS: Consumer-grade fitness trackers appear promising in hospitalized patients for monitoring heart rate. TRIAL REGISTRATION: ClinicalTrials.gov NCT05418881; https://www.clinicaltrials.gov/ct2/show/NCT05418881.
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Eletrocardiografia , Monitores de Aptidão Física , Humanos , Frequência Cardíaca/fisiologia , Monitorização Fisiológica , Pacientes , Estudos ProspectivosRESUMO
BACKGROUND: Patients with facial paralysis are significantly limited in their quality of life (QoL). If no irreversible nerve damage is apparent, intensive training of the facial muscles is recommended in addition to drug-based therapy with cortisone. In order to improve training, we have developed a digital biofeedback mirror with motion magnification to indirectly influence the vegetative nervous system. OBJECTIVE: The aim of this work was to evaluate the reliability of the biofeedback program compared to clinical examination and classification according to House-Brackmann. METHODS: Our biofeedback system is similar to a mirror with the additional advantage of increasing a patient's self-control. It not only reflects the patient's image, but also potentiates movement through video processing and a magnifying function. For this purpose, patient's facial movements are filmed and amplified in real-time. Thus, even the smallest movements can be made visible and measured so that patients receive feedback on nerve regeneration. This can increase patient's motivation for daily facial muscle training and improve compliance. RESULTS: In the present study, restriction of QoL was evaluated and objectivized with Facial Clinimetric Evaluation Scale (FaCE) and Facial Disability Index (FDI) questionnaires. It was demonstrated that the patients' self-perception was associated with poor QoL. CONCLUSION: In the current study, measurement of the facial movements showed a reliable agreement with the clinical classification according to House-Brackmann. The biofeedback system is a reliable support tool during the regeneration phase in patients with facial paralysis..
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Biorretroalimentação Psicológica , Paralisia Facial , Músculos Faciais , Paralisia Facial/terapia , Humanos , Qualidade de Vida , Reprodutibilidade dos TestesRESUMO
While controlled ventilation is most frequently used during cardiopulmonary resuscitation (CPR), the application of continuous positive airway pressure (CPAP) and passive ventilation of the lung synchronously with chest compressions and decompressions might represent a promising alternative approach. One benefit of CPAP during CPR is the reduction of peak airway pressures and therefore a potential enhancement in haemodynamics. We therefore evaluated the tidal volumes and airway pressures achieved during CPAP-CPR. During CPR with the LUCAS™ 2 compression device, a manikin model was passively ventilated at CPAP levels of 5, 10, 20 and 30 hPa with the Boussignac tracheal tube and the ventilators Evita® V500, Medumat® Transport, Oxylator® EMX, Oxylog® 2000, Oxylog® 3000, Primus® and Servo®-i as well as the Wenoll® diver rescue system. Tidal volumes and airway pressures during CPAP-CPR were recorded and analyzed. Tidal volumes during CPAP-CPR were higher than during compression-only CPR without positive airway pressure. The passively generated tidal volumes increased with increasing CPAP levels and were significantly influenced by the ventilators used. During ventilation at 20 hPa CPAP via a tracheal tube, the mean tidal volumes ranged from 125 ml (Medumat®) to 309 ml (Wenoll®) and the peak airway pressures from 23 hPa (Primus®) to 49 hPa (Oxylog® 3000). Transport ventilators generated lower tidal volumes than intensive care ventilators or closed-circuit systems. Peak airway pressures during CPAP-CPR were lower than those during controlled ventilation CPR reported in literature. High peak airway pressures are known to limit the applicability of ventilation via facemask or via supraglottic airway devices and may adversely affect haemodynamics. Hence, the application of ventilators generating high tidal volumes with low peak airway pressures appears desirable during CPAP-CPR. The limited CPAP-CPR capabilities of transport ventilators in our study might be prerequisite for future developments of transport ventilators.
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Reanimação Cardiopulmonar/métodos , Pressão Positiva Contínua nas Vias Aéreas , Parada Cardíaca , Reanimação Cardiopulmonar/instrumentação , Estudos Cross-Over , Hemodinâmica , Humanos , Manequins , Pressão , Volume de Ventilação Pulmonar , Ventiladores MecânicosRESUMO
As the number of assembled genome and metagenome sequences continue to grow at an ever-increasing pace, so does the need for fast, flexible and automated pipelines for generating meaningful homologous relationships within and between these (meta)genomes. Such relationships, or lack thereof, are crucial for differentiating between microbial organisms and environments at compositional, functional and phylogenetic levels. Metaphor is a standalone application that identifies core genes, unique genes, orthologs and paralogs in complex genomic datasets. It is not only limited to isolate genomes, but can also be applied to metagenomes due to its flexible implementation of Bi-directional Best Hit analysis. Thus, Metaphor can be used for a variety of functional and phylogenetic applications on a multitude of (meta)genome datasets.
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Lactobacillus/genética , Metagenoma , Alinhamento de Sequência/métodos , Análise de Sequência de DNA/métodos , Software , FilogeniaRESUMO
BACKGROUND: Drowning is a relevant worldwide cause of severe disability and death. The delay of ventilations and chest compressions is a crucial problem in drowning victims. Hence, a novel helicopter-based ALS rescue concept with in-water ventilation and chest compressions was evaluated. METHODS: Cardio pulmonary resuscitation (CPR) and vascular access were performed in a self-inflating Heliboat platform in an indoor wave pool using the Fastrach intubating laryngeal mask, the Oxylator resuscitator, Lund University Cardiopulmonary Assist System (LUCAS) chest compression device and EZ-IO intraosseous power drill. The time requirement and physical exertion on a Visual Analogue Scale (VAS) were compared between a procedure without waves and with moderate swell. RESULTS: Measurement of the elapsed time of the various stages of the procedure did not reveal significant differences between calm water and swell: Ventilation was initiated after 02:48 versus 03:02 and chest compression after 04:20 versus 04:18â min; the intraosseous cannulisation was completed after 05:59 versus 06:30â min after a simulated jump off the helicopter. The attachment of the LUCAS to the mannequin and the intraosseous cannulisation was rated significantly more demanding on the VAS during swell conditions. CONCLUSIONS: CPR appears to be possible when performed in a rescue platform with special equipment. The novel helicopter-based strategy appears to enable the rescuers to initiate CPR in an appropriate length of time and with an acceptable amount of physical exertion for the divers. The time for the helicopter to reach the patient will have to be very short to minimise neurological damage in the drowning victim.
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Resgate Aéreo , Manuseio das Vias Aéreas/métodos , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Afogamento Iminente/terapia , Estudos Cross-Over , Humanos , Manequins , Projetos Piloto , Distribuição Aleatória , Movimentos da ÁguaRESUMO
Introduction: Fitness trackers can provide continuous monitoring of vital signs and thus have the potential to become a complementary, mobile and effective tool for early detection of patient deterioration and post-operative complications. Methods: To evaluate potential implementations in acute care setting, we included 36 patients after moderate to major surgery in a recent randomised pilot trial to compare the performance of vital sign monitoring by three different fitness trackers (Apple Watch 7, Garmin Fenix 6pro and Withings ScanWatch) with established standard clinical monitors in post-anaesthesia care units and monitoring wards. Results: During a cumulative period of 56 days, a total of 53,197 heart rate (HR) measurements, as well as 12,219 measurements of the peripheral blood oxygen saturation (SpO2) and 28,954 respiratory rate (RR) measurements were collected by fitness trackers. Under real-world conditions, HR monitoring was accurate and reliable across all benchmarked devices (r = [0.95;0.98], p < 0.001; Bias = [-0.74â bpm;-0.01â bpm]; MAPEâ¼2%). However, the performance of SpO2 (r = [0.21;0.68]; p < 0.001; Bias = [-0.46%;-2.29%]; root-mean-square error = [2.82%;4.1%]) monitoring was substantially inferior. RR measurements could not be obtained for two of the devices, therefore exclusively the accuracy of the Garmin tracker could be evaluated (r = 0.28, p < 0.001; Bias = -1.46/min). Moreover, the time resolution of the vital sign measurements highly depends on the tracking device, ranging from 0.7 to 117.94 data points per hour. Conclusion: According to the results of the present study, tracker devices are generally reliable and accurate for HR monitoring, whereas SpO2 and RR measurements should be interpreted carefully, considering the clinical context of the respective patients.
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OBJECTIVE: Drowning is associated with a high mortality and morbidity and a common cause of death. In-water resuscitation (IWR) in the case of drowning accidents has been recommended by certain resuscitation guidelines in the last several years. IWR has been discussed controversially in the past, especially with regard to the delay of chest compressions, effectiveness of ventilation, and hazard to the rescuer. The aim of the present study was to assess the effectiveness and safety of IWR. METHODS: In this crossover manikin study, 21 lifeguards and 21 laypersons performed two rescue procedures in an indoor swimming pool over a 50-meter distance: In random order, one rescue procedure was performed with in-water ventilation and one without. Tidal and minute volumes were recorded using a modified Laerdal Resusci Anne (Laerdal Medical, Stavanger, Norway) and total rescue duration, submersions, water aspiration by the victim, and physical effort were assessed. RESULTS: IWR resulted in significant increases in rescue duration (lifeguards: 106 vs. 82 seconds; laypersons: 133 vs. 106 seconds) and submersions (lifeguards: 3 vs. 1; laypersons: 5 vs. 0). Furthermore, water aspiration (lifeguards: 112 vs. 29 mL; laypersons: 160 vs. 56 mL) and physical effort (lifeguards: visual analog scale [VAS] score 7 vs. 5; laypersons: VAS score 8 vs. 6) increased significantly when IWR was performed. Lifeguards achieved significantly better ventilation characteristics and performed both rescue procedures faster and with lower side effects. IWR performed by laypersons was insufficient with regard to both tidal and minute volumes. CONCLUSIONS: In-water resuscitation is associated with a delay of the rescue procedure and a relevant aspiration of water by the victim. IWR appears to be possible when performed over a short distance by well-trained professionals. The training of lifeguards must place particular emphasis on a reduction of submersions and aspiration when IWR is performed. IWR by laypersons is exhausting, time-consuming, and inefficient and should probably not be recommended. Key words: drowning; near-drowning; hypoxia; ventilation, artificial; respiration, artificial; resuscitation, in-water.
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Reanimação Cardiopulmonar/métodos , Manequins , Afogamento Iminente/terapia , Estudos Cross-Over , Humanos , Esforço Físico , Segurança , Fatores de TempoRESUMO
INTRODUCTION: In water resuscitation has been reported to enhance the outcome of drowning victims. Mouth-to-mouth ventilation during swimming is challenging. Therefore, the efficacy of ventilation utilities was evaluated. METHODS: Ventilation was assessed with the Oxylator ventilator, as well as the consecutive self-contained underwater breathing apparatus (SCUBA) regulators using an anaesthetic test lung: Poseidon Cyklon 5000, Poseidon XStream, Apeks TX 100, Spiro Arctic, Scubapro Air2 and Buddy AutoAir. RESULTS: Oxylator, Apeks TX 100, Arctic and Buddy AutoAir delivered reliable peak pressures and tidal volumes. In contrast, the ventilation parameters remarkably depended on duration and depth of pressing the purge button in Poseidon Cyklon 5000, Poseidon XStream and Scubapro Air2. Critical peak pressures occurred during ventilation with all these three regulators. DISCUSSION: The use of Poseidon Cyklon 5000, Poseidon XStream and Scubapro Air2 regulators is consequently not recommended for in-water ventilation. With the limitation that the devices were tested with a test lung and not in a human field study, Apeks TX 100, Spiro Arctic and Buddy AutoAir might be used for emergency ventilation and probably ease in-water resuscitation for the dive buddy of the victim. Professional rescue divers could be equipped with the Oxylator and an oxygen tank to achieve an early onset of efficient in-water ventilation in drowning victims.
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Mergulho , Tratamento de Emergência/métodos , Afogamento Iminente/terapia , Respiração Artificial/instrumentação , Ressuscitação/métodos , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Estudos de Viabilidade , Humanos , Máscaras Laríngeas , Manequins , Afogamento Iminente/prevenção & controle , Posicionamento do Paciente/métodos , Projetos Piloto , Reprodutibilidade dos Testes , Respiração Artificial/normas , Testes de Função Respiratória , Volume de Ventilação Pulmonar , Resultado do TratamentoRESUMO
Blood oxygen saturation is an important clinical parameter, especially in postoperative hospitalized patients, monitored in clinical practice by arterial blood gas (ABG) and/or pulse oximetry that both are not suitable for a long-term continuous monitoring of patients during the entire hospital stay, or beyond. Technological advances developed recently for consumer-grade fitness trackers could-at least in theory-help to fill in this gap, but benchmarks on the applicability and accuracy of these technologies in hospitalized patients are currently lacking. We therefore conducted at the postanaesthesia care unit under controlled settings a prospective clinical trial with 201 patients, comparing in total >1,000 oxygen blood saturation measurements by fitness trackers of three brands with the ABG gold standard and with pulse oximetry. Our results suggest that, despite of an overall still tolerable measuring accuracy, comparatively high dropout rates severely limit the possibilities of employing fitness trackers, particularly during the immediate postoperative period of hospitalized patients.
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UNLABELLED: Diving with self-contained underwater breathing apparatus (SCUBA) has become a popular recreational activity in children and adolescents. This article provides an extensive review of the current literature. CONCLUSIONS: Medical contraindications to SCUBA diving for adults apply to children and adolescents, too, but must be adapted. Additional restrictions to the fitness to dive must apply to both, children and adolescents. Children should always be accompanied by a trained adult when diving.
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Mergulho , Equipamentos Esportivos , Adolescente , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/prevenção & controle , Criança , Humanos , Fatores de RiscoRESUMO
OBJECTIVE: Hydrodynamic theories of idiopathic normal pressure hydrocephalus (iNPH) favor a decrease in compliance as an important underlying principle of the disease's immanent pathophysiology. ICP overnight monitoring (ONM) and lumbar infusion study (LIS) are both established methods that aid as supplemental tests in the selection of shunt-responsive patients. Pulse wave amplitude (AMP) and RAP index are measures derived from ONM and are related to intracranial compliance. Elastance (E) and pressure volume index (PVI), parameters derived from LIS, also describe the compliance of the system. We investigated whether the parameters of the two methods correlat with each other. METHODS: Thirty-three patients with probable/possible NPH underwent ICP overnight monitoring and a lumbar infusion study in supine position with ICP recorded from the intracranial compartment. RESULTS: E and PVI from the lumbar infusion study did not correlate at all with RAP or AMP from ICP monitoring. A qualitative change of the RAP and E pointing towards the same direction of either increased or decreased compliance, however, was found in 60.6% of our patients. CONCLUSION: Although data from the infusion test and from overnight monitoring of ICP describe the underlying pathophysiology in at least 60% of patients qualitatively in the same way; there is no direct correlation of parameters. This indicates that the underlying mechanisms of RAP are different from those in principle or in reaction time that are responsible for E.
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Hidrocefalia de Pressão Normal/fisiopatologia , Pressão Intracraniana , Monitorização Fisiológica/métodos , Estatística como Assunto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Análise Numérica Assistida por ComputadorRESUMO
BACKGROUND: Guidelines recommend maintaining the heart rate (HR) of acute stroke patients within physiological limits; data on the frequency and predictors of significant deviations from these limits are scarce. METHODS: Demographical data, stroke risk factors, NIH stroke scale score, lesion size and location, and ECG parameters were prospectively assessed in 256 patients with ischemic stroke. Patients were continuously monitored for at least 24 hours on a certified stroke unit. Tachycardia (HR ≥ 120 bpm) and bradycardia (HR <45 bpm) and cardiac rhythm (sinus rhythm or atrial fibrillation) were documented. We investigated the influence of risk factors on HR disturbances and their respective influence on dependence (modified Rankin Scale ≥ 3 after three months) and mortality. RESULTS: HR ≥ 120 bpm occurred in 39 patients (15%). Stroke severity (larger lesion size/higher NIHSS-score on admission), atrial fibrillation and HR on admission predicted its occurrence. HR <45 bpm occurred in 12 patients (5%) and was predicted by lower HR on admission. Neither HR ≥ 120 nor HR <45 bpm independently predicted poor outcome at three moths. Stroke location had no effect on the occurrence of HR violations. Clinical severity and age remained the only consistent predictors of poor outcome. CONCLUSIONS: Significant tachycardia and bradycardia are frequent phenomena in acute stroke; however they do not independently predict clinical course or outcome. Continuous monitoring allows detecting rhythm disturbances in stroke patients and allows deciding whether urgent medical treatment is necessary.
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Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Frequência Cardíaca/fisiologia , Monitorização Fisiológica/métodos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Arritmias Cardíacas/fisiopatologia , Comorbidade , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva/normas , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Prognóstico , Estudos Prospectivos , Acidente Vascular Cerebral/enfermagemRESUMO
The purpose of this study was to monitor heart rate (HR) and rhythm during open water SCUBA dives. Nine children performed 25-min open water SCUBA dives to 8 m depth. Before, during and after these dives, ECG was recorded. Compared with predive heart rate, heart rate declined by -24 ± 8% (range -36%; -15%) during the dive. In some children a further decline in HR was observed within the last minutes of the dive. Older and taller subjects and those with a high initial HR showed a more pronounced decline in HR. Furthermore singular supraventricular and ventricular extrasystoles were observed in some children. Immersion as well as facial and skin cooling presumably account for the initial decline in heart rate. A further drop in HR within the last minutes of the dive might be related to mild hypothermia. Single supraventricular and ventricular extrasystoles might occur in healthy children during dives.
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Adaptação Fisiológica/fisiologia , Mergulho/efeitos adversos , Frequência Cardíaca , Estresse Fisiológico/fisiologia , Fatores Etários , Austrália , Índice de Massa Corporal , Criança , Mergulho/fisiologia , Eletrocardiografia , Feminino , Humanos , Masculino , Estatísticas não Paramétricas , Inquéritos e Questionários , Sístole , Fatores de TempoRESUMO
PURPOSE: Proper fixation of central venous catheters (CVCs) is an integral part of safety to avoid dislodgement and malfunction. However, the effectiveness of different CVC securement sutures is unknown. METHODS: Analysis of maximum dislodgement forces for CVCs from three different manufacturers using four different suture techniques in an in vitro tensile loading experiment: 1. "clamp only", 2. "clamp and compression suture", 3. "finger trap" and 4. "complete", i.e., "clamp + compression suture + finger trap". Twenty-five tests were performed for each of the three CVC models and four securement suture techniques (n = 300 test runs). RESULTS: The primary cause of catheter dislodgement was sliding through the clamp in techniques 1 and 2. In contrast, rupture of the suture was the predominant cause for dislodgement in techniques 2 and 3. Median (IQR 25-75%) dislodgement forces were 26.0 (16.6) N in technique 1, 26.5 (18.8) N in technique 2, 76.7 (18.7) N in technique 3, and 84.8 (11.8) N in technique 4. Post-hoc analysis demonstrated significant differences (P < .001) between all pairwise combinations of techniques except technique 1 vs. 2 (P = .98). CONCLUSIONS: "Finger trap" fixation at the segmentation site considerably increases forces required for dislodgement compared to clamp-based approaches.
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Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais/efeitos adversos , Técnicas de Sutura/normas , Animais , Infecções Relacionadas a Cateter/etiologia , Bovinos , Estudos Cross-Over , Humanos , Suturas/tendênciasRESUMO
Intracellular calcium is an important second messenger that regulates many cell functions. Recent studies have shown that calcium ions can also regulate the cellular responses to ionizing radiation. However, previous data are restricted to cells treated with low-LET radiations (X rays, gamma rays and beta particles). In this work, we investigated the calcium levels in cells exposed to heavy-ion radiation of high LET. The experiments were performed at the single ion hit facility of the GSI heavy-ion microprobe. Using a built-in online calcium imaging system, the intracellular calcium concentrations were examined in HeLa cells and human foreskin fibroblast AG1522-D cells before and after irradiation with 4.8 MeV/nucleon carbon or argon ions. Although the experiment was sensitive enough to detect the calcium response to other known stimuli, no response to heavy-ion radiation was found in these two cell types. We also found that heavy-ion radiation has no impact on calcium oscillation induced by hypoxia stress in fibroblast cells.
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Cálcio/metabolismo , Células Epiteliais/metabolismo , Células Epiteliais/efeitos da radiação , Íons Pesados , Linhagem Celular , Relação Dose-Resposta à Radiação , Células HeLa , Humanos , Doses de RadiaçãoRESUMO
OBJECT: A decompressive craniectomy can be a life-saving procedure to relieve critically increased intracranial pressure. The survival of a patient is important as well as the subsequent and long-term quality of life. In this paper the authors' goal was to investigate whether long-term clinical results justify the use of a decompressive craniectomy. METHODS: Thirty-three patients (20 males and 13 females) with a mean age of 36.3 years (range 13-60 years) with severe traumatic brain injury (Grades III and IV) and subsequent massive brain swelling were examined. For postoperative assessment the Barthel Index was used. A surgical intervention was based on the following criteria: 1) The intracranial pressure could not be controlled by conservative treatment and constantly exceeded 30 mm Hg (cerebral perfusion pressure<50 mm Hg). 2) Transcranial Doppler ultrasonography revealed only a systolic flow pattern or systolic peaks. 3) There were no other major injuries. 4) The patient was not older than 60 years. RESULTS: One-fifth of all patients died and one-fifth remained in a vegetative state. Mild deficits were seen in 6 of 33 patients. A full rehabilitation (Barthel Index 90-100) was achieved in 13 patients (39.4%). Five patients could resume their former occupation, and another 4 had to change jobs. CONCLUSIONS: Age remains to be one of the most important exclusion factors. Decompressive craniectomy provided good clinical results in nearly 40% of patients who were otherwise most likely to die. Therefore, long-term results justify the use of decompressive craniectomy in this case series.
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Edema Encefálico/cirurgia , Lesões Encefálicas/cirurgia , Craniotomia , Descompressão Cirúrgica , Hipertensão Intracraniana/cirurgia , Adolescente , Adulto , Edema Encefálico/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Circulação Cerebrovascular , Feminino , Seguimentos , Humanos , Hipertensão Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X , Índices de Gravidade do Trauma , Resultado do Tratamento , Ultrassonografia Doppler TranscranianaRESUMO
The tone of the intraoral und pharyngeal muscles of the upper airway is of particular importance for the development of snoring. By increasing the tone with electrical stimulation, a reduction in snoring may be achieved. The aim of the study was to record the effects of intraoral muscle stimulation during the day on snoring at night. The prospective bi-centric study included 16 patients with snoring and mild obstructive sleep apnoea (Apnoea Hypopnoea Index [AHI]â¯< 15, BMIâ¯< 32). After initial polygraphy, snoring was monitored over 2 weeks (baseline) using a visual analogue scale (VAS; 0-10). This was followed by a 6-week treatment phase (2â¯× 20â¯min daily) with an intraoral electrical stimulation device. During and up to 2 weeks after therapy, snoring intensity in addition to use and potential side effects were documented on a daily basis. Three patients discontinued therapy because of technical problems. The 13 remaining patients (11 male/2 female, BMI 26.9⯱ 3.2, AHI 9.3⯱ 4.6) underwent per-protocol analysis. The mean snoring score was reduced from 5.6⯱ 1.1 (baseline) to 3.2⯱ 2.7 (after therapy) and remained stable until 2 weeks after treatment (3.3⯱ 2.4). In 7 patients (53.9%) the score was reduced by more than 50%. Patients with an AHIâ¯< 10 responded better to therapy. No unexpected events occurred. In the present pilot study, the first signs of the effectiveness of intraoral muscle stimulation in snoring patients were shown. In addition to a technical improvement of the stimulator, carrying out controlled trials and assessing potential influencing factors on the success of therapy are necessary.
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INTRODUCTION: Macrophages/microglial cells are considered as immune cells in the central nervous system. Interleukin (IL)-16 is a proinflammatory cytokine produced by activated monocytic cells. MATERIALS AND METHODS: Expression of IL-16 was analyzed by immunohistochemistry in human astrocytic brain tumors and the rat C6 glioblastoma tumor model. IL-16 was detected in both human astrocytic brain tumors and rat C6 glioma. RESULTS: Compared with human control brains, a significant increase in the percentages of parenchymal IL-16+ macrophages/microglia was observed already in grade II astrocytomas, indicating that IL-16+ immunostaining could be a descriptor of a macrophage/microglia subset in astrocytic brain tumors. A further increase was observed at the transition from grade II to III astrocytomas. This increase in IL-16 immunoreactivity correlated with WHO grades of human astrocytic brain tumors. CONCLUSIONS: Therefore, IL-16 might be a so far unknown factor in the regulation of the local inflammatory milieu of human and experimental astrocytomas.
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Astrocitoma/imunologia , Neoplasias Encefálicas/imunologia , Glioblastoma/imunologia , Interleucina-16/biossíntese , Macrófagos/imunologia , Microglia/imunologia , Adulto , Idoso , Animais , Astrocitoma/metabolismo , Neoplasias Encefálicas/metabolismo , Linhagem Celular Tumoral , Feminino , Glioblastoma/metabolismo , Glioblastoma/patologia , Humanos , Mediadores da Inflamação/metabolismo , Macrófagos/patologia , Masculino , Microglia/metabolismo , Pessoa de Meia-Idade , Ratos , Ratos Sprague-DawleyRESUMO
BACKGROUND: Shunt infection in hydrocephalus patients is a severe, even life-threatening complication. Antibiotic-impregnated shunts (AIS) have been developed in an attempt to reduce rate of shunt infection. The study was performed to analyze if AIS can diminish the rate of shunt infection. The pathogenic nature of shunt infection in patients with AIS systems and those without antibiotic impregnated shunts (non-AIS) was compared. METHODS: Over a period of 24 months in the Department of Neurosurgery at University Hospital of Tübingen shunt surgery was performed in 258 patients. In 86 patients AIS systems were implanted. Shunt catheters were commercially impregnated with clindamycin and rifampicin. Analysis of the clinical data included sex, age, classification of hydrocephalus, shunt types and risk factors for shunt infection [age (< 1 year and > 80 years), prematurely born patients, external ventricular drainage, former shunt infection, former systemic infection, disturbance of consciousness, former radiation-/chemotherapy]. Infection rates and underlying bacterial pathogens of patients with AIS were compared to patients with implanted non-AIS systems (172 patients). RESULTS: AIS and non-AIS patients did not differ in sex, etiology of hydrocephalus and the shunt type. In the AIS group 72 out of 86 patients had at least one risk factor (83.7 %), compared to 126 patients in the non-AIS group (73.3 %). There was no significant difference between the two groups (p = 0.0629; Fisher's exact test). In patients with no risk factors, only one patient with non-AIS suffered from shunt infection. In patients with one or more risk factors the rate for shunt infection was 7.14 % in patients with non-AIS and 6.94 % in patients with AIS. Former shunt infection (p = 0.0124) was related to higher risk for shunt infection. The use of AIS had therefore no significant advantage (p = 0.8611; multiple logistic regression). Significantly related to a shunt infection was the number of shunt surgeries. 190 interventions in the AIS group (2.21 interventions per patient) and 408 in the non-AIS group (2.37 interventions per patient) had been performed (p = 0.3063; Wilcoxon). There was no shunt infection in the group of patients on whom only one shunt surgery was performed. In patients with at least two shunt surgeries the infection rate was 9%. The infection rate in AIS patients was 5/52 (9.6 %) and in the non-AIS 10/114 (8.77 %), (p = 1.0; Fisher's exact test). Staphylococcus epidermidis was the most frequent pathogen for shunt infection. Fourteen out of 15 infections occurred within the first 6 months of surgery. The most frequent pathogen for shunt infection was S. epidermidis. No toxic or allergic complications were seen using the AIS shunt systems. The presented data show a remarkably low infection rate of 5.8 % in the non-AIS group compared to other studies which demonstrated a significant decrease in the infection rate by AIS. CONCLUSION: AIS did not significantly reduce shunt infection in hydrocephalus patients in the presented study. In the AIS group three patients suffered from shunt infections caused by skin ulceration or neurosurgical procedures with exposure of the cerebrospinal liquor after shunt implantation. AIS was not developed to prevent infection in such cases, therefore an advantage of AIS can not be excluded. In view of the presented data and the small number of reported studies a prospective randomized multicenter study is required.
Assuntos
Antibacterianos/administração & dosagem , Derivações do Líquido Cefalorraquidiano/métodos , Clindamicina/administração & dosagem , Hidrocefalia/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Rifampina/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/líquido cefalorraquidiano , Hidrocefalia/microbiologia , Lactente , Masculino , Pessoa de Meia-Idade , Observação , Infecções Relacionadas à Prótese/líquido cefalorraquidiano , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologiaRESUMO
OBJECTIVE: Cardiac arrest is associated with a poor outcome if cardiopulmonary resuscitation (CPR) is delayed. Nevertheless, CPR performance by laypersons in witnessed cardiac arrest is frequently poor. The present study evaluated the effect of a media campaign on CPR performance. PARTICIPANTS AND METHODS: CPR performance of 1000 individuals who did not have any medical background was evaluated using a resuscitation manikin. The media campaign consisted of flyers, posters, and electronic advertisement. Five hundred individuals were evaluated before the media campaign and 500 individuals after the media campaign. Age and male/female ratio were comparable within each of the groups. Premedia campaign performance was compared with postmedia campaign performance with respect to chest compressions and ventilation metrics. RESULTS: Chest compression depth and total compression work were significantly higher after the media campaign: median depth 51 mm postcampaign versus 45 mm precampaign (P<0.001), median cumulative compression work postcampaign 4176 versus 2462 mm precampaign (P<0.001). Tidal volumes and ventilation work were significantly lower following the media campaign, but did not differ between participants who had acknowledged exposure to the campaign and those who did not. Ventilation performance was generally poor across the two groups both before and after the media campaign. CONCLUSION: A simple and cost-efficient media campaign appears to enhance the performance of chest compressions. Ventilation performance and the rate of CPR performance were not increased by the campaign.