Τετάρτη, 10 Φεβρουαρίου 2016

Operationen in einkommensschwachen Ländern bald ohne Anästhetika?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 1-1
DOI: 10.1055/s-0042-101152



© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text



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Qualität der Schmerztherapie in Deutschland – Organisation der Akutschmerztherapie: Leitlinien, Empfehlungen und aktuelle Praxis

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 40-48
DOI: 10.1055/s-0041-101757

Organisatorische Voraussetzungen und die Aus- und Weiterbildung von Klinikmitarbeitern schaffen die Basis für eine adäquate Versorgungsqualität der Akutschmerztherapie und sollten im Fokus der Bemühungen stehen. Obwohl organisatorische Empfehlungen der S3- Leitlinie zur „Behandlung akuter perioperativer und posttraumatischer Schmerzen" in der vergangenen Jahren zunehmend etabliert wurden, besteht dennoch in vielen deutschen Krankenhäusern noch erheblicher Nachholbedarf in der Umsetzung allgemeiner Versorgungsvoraussetzungen, wie der regelmäßigen Schmerzmessung oder der Einführung von geeigneten Behandlungsstandards für alle Arbeitsbereiche des Krankenhauses. Als spezialisierte Versorgungsstrukturen sind zwar in 80% der Krankenhäuser Akutschmerzdienste implementiert, jedoch erfüllen nur 45% davon Qualitätskriterien. Aufgrund der sehr heterogenen Umsetzung der Akutschmerztherapie wird deutlich, dass es trotz allgemeiner Leitlinienempfehlungen verbindlicher Definitionen für die Struktur- und Qualitätskriterien bedarf.
[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  CME online  |  Full text



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IntelliCuff ─ Ensuring Cuff Pressure and Patient Safety

After successful FDA approval, Hamilton Medical is launching the IntelliCuff® pressure controller in the US. Previously available as an option for the ventilator HAMILTON-G5, the innovative IntelliCuff technology has now been given its own housing. The ergonomic, hand held device is now available for use with all mechanical ventilators. The IntelliCuff® pressure controller continuously measures ...

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The Association Between Postnatal Depression, Acculturation and Mother–Infant Bond Among Eritrean Asylum Seekers in Israel

Abstract

We examined the association between postnatal depression (PND), acculturation and mother–infant bond among 38 Eritrean asylum seekers in Israel, who were within 6 months of delivery. Participants completed a survey in their native language. A high rate of women (81.6 %) met the clinical threshold for PND on the Edinburgh Postnatal Depression Scale. Higher severity of PND (partial r = −.64, p < .001), higher identification with Israeli culture (partial r = −.45, p = .02), and lower quality of romantic relationship were associated with impaired mother–infant bond (partial r = .58, p = .002). Findings highlight the need to establish services to screen and treat PND among this vulnerable population in the receiving countries.



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Awareness of Hepatitis C Virus Seropositivity and Chronic Infection in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Abstract

Few population-based studies have assessed awareness of hepatitis C virus (HCV) seropositivity and chronic infection. We report awareness of HCV seropositivity and chronic infection and correlates of awareness in a multi-city (Bronx, Miami, Chicago, and San Diego) community-dwelling population sample of United States (US) Hispanics/Latinos recruited during 2008–2011. Included were 260 HCV-seropositive participants, among whom 190 had chronic HCV. Among those with chronic HCV, 46 % had been told by a doctor that they had liver disease and 32 % had been told that they had HCV-related liver disease. Among those with chronic HCV who also lacked health insurance (37 % of those with chronic HCV), only 8 % had been told that they had HCV-related liver disease. As compared with the uninsured, those with insurance were over five times more likely to be aware of having HCV-related liver disease (44 %). Sex, age, education, city of residence, and birthplace were not associated with HCV awareness. Less than half of Hispanics/Latinos were aware of their HCV chronic infection. Lack of health insurance may be an important barrier to HCV awareness in this population.



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Randomized comparison of three transducer orientation approaches for ultrasound guided internal jugular venous cannulation

Background

Ultrasound-guided internal jugular venous access increases the rate of successful cannulation and reduces the incidence of complications, compared with the landmark technique. Three transducer orientation approaches have been proposed for this procedure: short-axis (SAX), long-axis (LAX) and oblique-axis (OAX). Our goal was to assess and compare the performance of these approaches.

Methods

A prospective randomized clinical trial was conducted in one teaching hospital. Patients aged 18 yr or above, who were undergoing ultrasound-guided internal jugular cannulation, were randomly assigned to one of three intervention groups: SAX, LAX and OAX group. The main outcome measure was successful cannulation on first needle pass. Incidence of mechanical complications was also registered. Restricted randomization was computer-generated.

Results

In total, 220 patients were analysed (SAX n=73, LAX n=75, OAX n=72). Cannulation was successful on first needle pass in 51 (69.9%) SAX patients, 39 (52%) LAX patients and 53 (73.6%) OAX patients. First needle pass failure was higher in the LAX group than in the OAX group (adjusted OR 3.7, 95% CI 1.71–8.0, P=0.002). A higher mechanical complication rate was observed in the SAX group (15.1%) than in the OAX (6.9%) and LAX (4%) groups (P=0.047).

Conclusions

As OAX showed a higher first needle pass success rate than LAX and a lower mechanical complications rate than SAX, we recommend it as the standard approach when performing ultrasound-guided internal jugular venous access. Further clinical studies are needed to confirm this conclusion.

Clinical trial registration

NCT 01966354



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Emergence delirium or pain after anaesthesia--how to distinguish between the two in young children: a retrospective analysis of observational studies

Background

Early postoperative negative behaviour in preschool children after general anaesthesia is a common problem. The distinction between emergence delirium (ED) and pain is difficult, but management differs between the two. The aim of the current analysis was to identify individual observational variables that can be used to diagnose ED and allow distinction from postoperative pain.

Methods

This retrospective analysis of data from three previous prospective observational studies included children undergoing general anaesthesia for elective adeno-tonsillectomy, sub-umbilical surgery, and MRI scanning. Two trained observers simultaneously applied the Face, Legs, Activity, Cry, Consolability Scale; the Children's Hospital Eastern Ontario Pain Scale; the Children's and Infants' Postoperative Pain Scale or the Paediatric Anaesthesia Emergence Delirium (PAED) scale. Data from each domain of the scales were available at awakening and at five, 10, and 15 min after anaesthesia. Each patient was analysed over time, and subsequently, each evaluation was considered as a single event. The descriptive behaviour items overlapping in the assessed scales were identified as dichotomous variable ('true/false') and then were applied for each evaluation.

Results

Children (n=512) were assessed for a total of 2048 evaluations. Most children (69%) displayed at least one episode of ED and/or pain. Almost 15% of children demonstrated both ED and pain. Children with ED showed 'no eye contact' and 'no awareness of surroundings'. Children with pain displayed 'abnormal facial expression', 'crying', and 'inconsolability'.

Conclusions

'No eye contact' and 'no awareness of surroundings' identifies ED. 'Abnormal facial expression', 'crying', and 'inconsolability' indicate acute pain in children in the early postoperative period.



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Salt at fault?



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General Information



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Evidence for nociceptin/orphanin FQ (NOP) but not {micro} (MOP), {delta} (DOP) or {kappa} (KOP) opioid receptor mRNA in whole human blood

Background

While it is well known that opioids depress the immune system, the site(s) of action for this depression is highly controversial. Immune modulation could occur directly at the immune cell or centrally via the hypothalamic-pituitary-adrenal axis. In a number of studies using individual enriched immune cell populations we have failed to detect classical µ (MOP), (DOP) and (KOP) receptors. The non-classical nociceptin/orphanin FQ (N/OFQ) receptor (NOP) is expressed on all cells examined thus far. Our hypothesis was that immune cells do not express classical opioid receptors and that using whole blood would definitively answer this question.

Methods

Whole blood (containing all immune cell types) was incubated with opioids (morphine and fentanyl) commonly encountered in anaesthesia and with agents mimicking sepsis [lipopolysaccharide (LPS) and peptidoglycan G (PepG)]. Opioid receptor mRNA expression was assessed by endpoint polymerase chain reaction (PCR) with gel visualisation and quantitative PCR.

Results

Classical MOP, DOP, and KOP receptors were not detected in any of the samples tested either at rest or when challenged with opioids, LPS or PepG. Commercial primers for DOP did not perform well in quantitative PCR, so the absence of expression was confirmed using a traditional gel-based approach. NOP receptors were detected in all samples; expression was unaffected by opioids and reduced by LPS/PepG combinations.

Conclusions

Classical opioid receptors are not expressed on circulating immune cells.



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Contents Page



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Simulation as a set-up for technical proficiency: can a virtual warm-up improve live fibre-optic intubation?

Background

Fibre-optic intubation (FOI) is an advanced technical skill, which anaesthesia residents must frequently perform under pressure. In surgical subspecialties, a virtual 'warm-up' has been used to prime a practitioner's skill set immediately before performance of challenging procedures. This study examined whether a virtual warm-up improved the performance of elective live patient FOI by anaesthesia residents.

Methods

Clinical anaesthesia yr 1 and 2 (CA1 and CA2) residents were recruited to perform elective asleep oral FOI. Residents either underwent a 5 min, guided warm-up (using a bronchoscopy simulator) immediately before live FOI on patients with predicted normal airways or performed live FOI on similar patients without the warm-up. Subjects were timed performing FOI (from scope passing teeth to viewing the carina) and were graded on a 45-point skill scale by attending anaesthetists. After a washout period, all subjects were resampled as members of the opposite cohort. Multivariate analysis was performed to control for variations in previous FOI experience of the residents.

Results

Thirty-three anaesthesia residents were recruited, of whom 22 were CA1 and 11 were CA2. Virtual warm-up conferred a 37% reduction in time for CA1s (mean 35.8 (sd 3.2) s vs. 57 (sd 3.2) s, P<0.0002) and a 26% decrease for CA2s (mean 23 (sd 1.7) s vs. 31 (sd 1.7) s, P=0.0118). Global skill score increased with warm-up by 4.8 points for CA1s (mean 32.8 (sd 1.2) vs. 37.6 (sd 1.2), P=0.0079) and 5.1 points for CA2s (37.7 (sd 1.1) vs. 42.8 (sd 1.1), P=0.0125). Crossover period and sequence did not show a statistically significant association with performance.

Conclusions

Virtual warm-up significantly improved performance by residents of FOI in live patients with normal airway anatomy, as measured both by speed and by a scaled evaluation of skills.



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In the March BJA ...



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Is one acceleromyographically measured train-of-four ratio sufficient after sugammadex to identify residual curarization in postoperative, awake patients?



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The high-risk surgical patient: a role for a multi-disciplinary team approach?



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Clinical and pathophysiological issues associated with type 1 autoimmune pancreatitis

Abstract

In 1995, Yoshida and colleagues proposed the concept of 'autoimmune pancreatitis' (AIP). Recently, it is accepted that the existence of two subtypes of AIP—type 1, which involves immunoglobulin G4 (IgG4) as the pancreatic manifestation of IgG4-related disease (IgG4-RD), and type 2, which is characterized by granulocytic epithelial lesions. Type 2 AIP is thought to be rare in Japan. In 2011, the International Consensus Diagnostic Criteria (ICDC) for autoimmune pancreatitis was proposed. In Japan, the clinical diagnostic criteria of AIP 2011 was proposed by the Japan Pancreas Society (JPS) and the Research Committee of Intractable Diseases of the Pancreas. The JPS 2011 is based on ICDC and a simplified checklist of items to diagnose type 1 AIP. Although recent progress in type 1 AIP has resolved clinical features, diagnosis, treatment, and pathogenesis, many clinical and basic issues still remain unclear. Here, we provide an overview of the recent clinical and basic issues associated with type 1 AIP.



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Individualized Food-Based Dietary Therapy for Crohn’s Disease: Are We Making Progress?



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Dexmedetomidine post-treatment induces neuroprotection via activation of extracellular signal-regulated kinase in rats with subarachnoid haemorrhage

Background

Dexmedetomidine, a sedative agent, provides neuroprotection when administered during or before brain ischaemia. This study was designed to determine whether dexmedetomidine post-treatment induces neuroprotection against subarachnoid haemorrhage (SAH) and the mechanisms for this effect.

Methods

Subarachnoid haemorrhage was induced by endovascular perforation to the junction of the right middle and anterior cerebral arteries in adult rats. Dexmedetomidine was applied immediately or 2 h after onset of SAH. Neurological outcome was evaluated 2 days after SAH. Right frontal cortex area 1 was harvested 24 h after SAH for western blotting.

Results

Subarachnoid haemorrhage reduced neurological scores and increased brain oedema and blood–brain barrier permeability. These effects were attenuated by dexmedetomidine post-treatment. Neuroprotection by dexmedetomidine was abolished by PD98095, an inhibitor of extracellular signal-regulated kinase (ERK) activation. Phospho-ERK, the activated form of ERK, was increased by dexmedetomidine; this activation was inhibited by PD98095.

Conclusions

Dexmedetomidine post-treatment provides neuroprotection against SAH. This effect appears to be mediated by ERK.



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Improving procedural performance through warm-up and mental imagery



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Gastroenterology Training in Japan



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Cricoid pressure impedes tracheal intubation with the Pentax-AWS Airwayscope(R): a prospective randomized trial

Background

It is unclear how cricoid pressure affects tracheal intubation with the Pentax-AWS Airwayscope® (AWS). We conducted a prospective randomized clinical trial in anaesthetized patients.

Methods

Sixty patients were allocated to either the cricoid pressure (CP) group (n=30) or the sham group (n=30). We compared the two groups with regard to intubation time, number of attempts required for insertion of the Intlock blade (disposable blade of the AWS) and tracheal intubation, percentage of glottic opening (POGO) score, and subjective difficulty of both laryngoscopy and passage of a tube through the glottis.

Results

Intubation time was significantly longer in the CP group (median 45[IQR40–59] s) than in the sham group (32[28–45] s) (P=0.003, 95% CI for median difference 5–24 s). The number required for insertion of the Intlock blade did not differ between the groups (P=0.08), but the number for tracheal intubation was significantly higher in the CP group (1 attempt in 14 patients, 2 in 7, 3 in 9) than in the sham group (1 attempt in 24 patients, 2 in 6; P=0.002). POGO score did not differ significantly between the groups (P=0.60), nor did the subjective difficulty of laryngoscopy (P=0.06). The visual analogue scale score for passage of a tube through the glottis was significantly higher in the CP group than in the sham group (P<0.001).

Conclusions

Cricoid pressure impedes tracheal intubation using the AWS, and is associated with longer intubation time, which can be attributed to increased difficulty in the passage of a tube through the glottis.

Clinical Trial registry number

UMIN000018209.



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Videolaryngoscopes: do they have role during rapid-sequence induction of anaesthesia?



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Radiofrequency Ablation of Cameron Lesions



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Schneider regimen vs a volatile inhalation anaesthetic (desflurane) for laparoscopic adrenalectomy and additional considerations for delivery of anaesthesia



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Limitations of body mass index as an obesity measure of perioperative risk



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SEMS for Palliation of Malignant Colonic Obstruction: Why SEMi Available Is Not Good Enough



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Hidden universality of residual neuromuscular block



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Dual Alpha 2C /5HT 1A Receptor Agonist Allyphenyline Induces Gastroprotection and Inhibits Fundic and Colonic Contractility

Abstract

Background

Allyphenyline, a novel α2-adrenoceptor (AR) ligand, has been shown to selectively activate α2C-adrenoceptors (AR) and 5HT1A receptors, but also to behave as a neutral antagonist of α2A-ARs. We exploited this unique pharmacological profile to analyze the role of α2C-ARs and 5HT1A receptors in the regulation of gastric mucosal integrity and gastrointestinal motility.

Methods

Gastric injury was induced by acidified ethanol in Wistar rats. Mucosal catalase and superoxide dismutase levels were measured by assay kits. The effect of allyphenyline on electrical field stimulation (EFS)-induced fundic and colonic contractions was determined in C57BL/6 mice.

Results

Intracerebroventricularly injected allyphenyline (3 and 15 nmol/rat) dose dependently inhibited the development of mucosal damage, which was antagonized by ARC 239 (α2B/C-AR and 5HT1A receptor antagonist), (S)-WAY 100135 (selective 5HT1A receptor antagonist), and JP-1302 (selective α2C-AR antagonist). This protection was accompanied by significant elevation of mucosal catalase and superoxide dismutase levels. Allyphenyline (10−9–10−5 M) also inhibited EFS-induced fundic contractions, which was antagonized by ARC 239 and (S)-WAY 100135, but not by JP-1302. Similar inhibition was observed in the colon; however, in this case only ARC 239 reduced this effect, while neither selective inhibition of α2C-ARs and 5HT1A receptors nor genetic deletion of α2A- and α2B-ARs influenced it.

Conclusions

Activation of both central α2C-ARs and 5HT1A receptors contributes to the gastroprotective action of allyphenyline in rats. Its inhibitory effect on fundic contractions is mediated by 5HT1A receptors, but neither α2-ARs nor 5HT1A receptors take part in its inhibitory effect on colonic contractility in mice.



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The increasing recreational use of nitrous oxide: history revisited



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Opportunities for Improvement in the Care of Patients Hospitalized for Inflammatory Bowel Disease-Related Colitis

Abstract

Background

Algorithms for the diagnosis, management, and follow-up have been proposed for patients hospitalized for inflammatory bowel disease (IBD) colitis flare. The degree to which providers adhere to these algorithms is unknown. This study evaluated the quality of care in IBD patients hospitalized for disease-associated exacerbations and factors correlated with higher degrees of care.

Methods

Retrospective chart review of 34 patients during 60 admissions to the medicine service for IBD colitis exacerbation between 2005 and 2012 at the Veterans Affairs San Diego Medical Center. Examined factors included laboratory testing, timing of consultation and intravenous steroids, abdominal imaging, endoscopic examination, venous thromboembolism (VTE) prophylaxis, narcotic use, Clostridium difficile and cytomegalovirus testing, symptomatology at discharge, timing of follow-up, and rates of readmission and mortality.

Results

Quality of care varied among the factors studied, ranging from 30.5 % for pharmacologic VTE prophylaxis to 84.7 % for gastroenterology consultation within 24 h. Of 60 admissions, 22 % were not tested for C. difficile. Fifteen percent of patients were discharged before meeting commonly used discharge criteria. Eighty percent were seen in clinic at any time post-discharge; 6.7 % were readmitted; 10 % were lost to follow-up; 1.7 % opted for outside follow-up; and 1.7 % expired.

Conclusions

The quality of care for patients admitted with IBD colitis flares is variable. These data outline opportunities for improvement, particularly in regard to pain management, VTE prophylaxis, and follow-up. Further studies are needed to test intervention strategies for practice improvement.



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Reply from the authors * Individualized ventilatory strategy: ameliorate lung injury while preserving physiology



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Involvement of Transient Receptor Potential Vanilloid Receptor 1, (TRPV1)-Expressing Vagal Nerve in the Inhibitory Effect of Gastric Acidification on Exogenous Motilin-Induced Gastric Phase III Contractions in Suncus murinus

Abstract

Background

Gastric acidification inhibits motilin-induced gastric phase III contractions. However, the underlying mechanism has not been thoroughly investigated. Here, we studied the inhibitory mechanism by gastric acidification on motilin-induced contraction in Suncus murinus (S. murinus).

Methods

We measured interdigestive gastric phase III contractions in conscious, freely moving S. murinus, and examined the inhibitory effect of gastric acidification on motilin action and the involvement of the vagus nerve and transient receptor potential vanilloid receptor 1 (TRPV1) in the inhibitory mechanism.

Results

A bolus injection of motilin evoked phase III-like contractions during intravenous infusion of saline. Intragastric acidification (pH 1.5–2.5) inhibited motilin-induced phase III contractions in a pH-dependent manner and significantly decreased the motility index at a pH below 2.0. In contrast, intraduodenal acidification (pH 2.0) failed to inhibit motilin-induced contractions. Vagotomy significantly alleviated the suppression of motilin-induced gastric contractions under acidic conditions (pH 2.0), suggesting vagus nerve involvement. Moreover, intragastric acidification (pH 2.0) significantly increased the number of c-Fos-positive cells in the nucleus tractus solitarii. In vagotomized S. murinus, the number of c-Fos-positive cells did not change, even under gastric acidification conditions. TRPV1 mRNA was highly expressed in the muscle and mucosal regions of the antrum and the nodose ganglion, whereas was not detected in the upper small intestine. Capsazepin, a TRPV1 antagonist, completely rescued the inhibitory effect of gastric acidification.

Conclusions

Gastric acidification in S. murinus inhibits motilin-induced contractions, a finding similar to results observed in humans, while TRPV1-expressing vagus nerves play a role in the inhibitory mechanism.



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Ultrasound guided infraclavicular axillary vein cannulation, coming of age



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Acknowledgment of 2015 Reviewers



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Endoscopic treatment for esophageal varices complicated by Isaacs' syndrome involving difficulty with conventional sedation

Abstract

A 54-year-old male consulted a local doctor with a chief complaint of systemic convulsions and muscle stiffness and was diagnosed with Isaacs' syndrome based on positive findings for antibodies against voltage-gated potassium channels in 2009. He subsequently experienced repeated hematemesis in 2013, at which time he was taken to our hospital by ambulance. Emergent endoscopy revealed esophageal varices with spurting bleeding. The bleeding was stopped with urgent endoscopic variceal ligation. Three days later, the patient developed sudden dyspnea with stridor during inspiration under sedation with an intravenous injection of low-dose flunitrazepam prior to receiving additional treatment and was aroused with intravenous flumazenil, after which his dyspnea immediately improved. Dyspnea may be induced by muscle cramps associated with Isaacs' syndrome exacerbated by sedation. Endoscopic variceal ligation was performed safely using multiple ligation devices in an awake state following pre-medication with hydroxyzine, without sudden dyspnea. Endoscopists should be cautious of the use of sedatives in patients with diseases associated with muscle twitching or stiffness, as in the current case. In addition, it is necessary to administer endoscopic treatment in an awake state or under conscious sedation in patients with a high risk of dyspnea.



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Remember 2 Things: Anaphylaxis and lower airway assessment

Anaphylaxis is a difficult patient presentation. Review two important assessments for lower airway compromise caused by an allergic reaction. Auscultate the patient's lungs for wheezes, starting in the upper lung lobes and listening downward. Also make sure you can distinguish absent lung sounds from clear lung sounds. Finally, remember to listen to lots and lots of lung sounds so you can learn to distinguish normal from abnormal. After watching read more about anaphylaxis assessment and treatment.

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Remember 2 Things: Anaphylaxis and lower airway assessment

Anaphylaxis is a difficult patient presentation. Review two important assessments for lower airway compromise caused by an allergic reaction. Auscultate the patient's lungs for wheezes, starting in the upper lung lobes and listening downward. Also make sure you can distinguish absent lung sounds from clear lung sounds. Finally, remember to listen to lots and lots of lung sounds so you can learn to distinguish normal from abnormal. After watching read more about anaphylaxis assessment and treatment.

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Remember 2 Things: Anaphylaxis and upper airway assessment

Anaphylaxis is a difficult patient presentation. Review two important assessments for upper airway compromise caused by an allergic reaction. Auscultate the patient's trachea and remember facial swelling means upper airway swelling. After watching read more about anaphylaxis assessment and treatment.

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DC Fire and EMS: The shame of EMS

The never-ending story of DC Fire and EMS, a department that supposedly protects the health and welfare of our nation's capital citizens and visitors, has yet again closed another chapter filled with failed policies, indifferent leadership and lousy public safety.

With the resignation of Dr. Jullette Saussy, another well-intentioned physician trying to make a difference, DCFEMS once again proves that organizations will always rise — or sink — to the level of incompetency that pervades the system.

At least this time a small snippet of the curtain was lifted away for a moment, allowing Washington DC's naive political leadership an opportunity to glimpse at what most of us EMS industry insiders have known for decades — don't get sick in the District and expect any level of competent care to arrive at your door in some reasonable amount of time.

House on fire" Sure, DC fire can handle that. Though fires only happen a handful of times a year, they spend an enormous amount of money on fire suppression. And there is such an overload of staffing to take care of those rare fires; how could they not manage a house fire"

But to handle the hundreds of daily medical calls, for some reason that doesn't really matter to DCFEMS leaders.

I suspect that more people die within the district each week from a sudden cardiac arrest than from the fires that have raged in the district over the past ten years. How many of these individuals could be saved if even an average medical response was mounted"

What about heart attacks" Strokes" Hemorrhage" Complicated childbirth" Traumatic brain injury" Asthma attacks"

Each of these patient subsets have a time interval where prompt, accurate care can make a difference in how someone survives — and thrives — after the event.

It appears that the DCFEMS leaders and personnel must not live within the District, or have family or friends who reside there. Otherwise I have to believe that there would be some tinge of guilt or remorse that they collect a paycheck for working in a system that doesn't serve a purpose.

Over the decades I've seen incident after incident of incompetency reported about DCFEMS. I used to believe that some of our smartest, wisest and most committed citizens work in the District, for the greater good of the country. Clearly that's not the case within DCFEMS nor in the leadership of Washington DC.

It also seems pretty clear that this is the picture of EMS that our U.S. senators and representatives, and their staff, working in the Capital see when they walk down the boulevards of the capital city. How much of that viewpoint colors and distorts the EMS discussion on the national level"

DCFEMS, the shame of EMS.



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Best cakes for EMS providers

Many providers share their passion for EMS and firefighting with their significant other, so why not opt for a first-responder-themed cake for Valentine's Day"

EMS1's readers shared many photos of the cakes they had for graduations, retirements and birthdays. Take a look at our favorites and share your best EMS-themed cake with us! Email editor@ems1.com.



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The zebrafish fast myosin light chain mylpfa:H2B-GFP transgene is a useful tool for in vivo imaging of myocyte fusion in the vertebrate embryo

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Publication date: Available online 10 February 2016
Source:Gene Expression Patterns
Author(s): Weibin Zhang, Sudipto Roy
BackgroundSkeletal muscle fibers are multinucleated syncytia that arise from the fusion of mononucleated precursors, the myocytes, during embryonic development, muscle hypertrophy in post-embryonic growth and muscle regeneration after injury. Even though myocyte fusion is central to skeletal muscle differentiation, our current knowledge of the molecular mechanism of myocyte fusion in the vertebrates is rather limited. Previous work, from our group and others, has shown that the zebrafish embryo is a very useful model for investigating the cell biology and genetics of vertebrate myocyte fusion in vivo.ResultsHere, we report the generation of a stable transgenic zebrafish strain that expresses the Histone 2B-GFP (H2B-GFP) fusion protein in the nuclei of all fast-twitch muscle fibers under the control of the fast-twitch muscle-specific myosin light chain, phosphorylatable, fast skeletal muscle a (mylpfa) gene promoter. By introducing this transgene into a mutant for junctional adhesion molecule 3b (jam3b), which encodes a cell adhesion protein previously implicated in myocyte fusion, we demonstrate the feasibility of using this transgene for the analysis of myocyte fusion during the differentiation of the trunk musculature of the zebrafish embryo.ConclusionsSince we know so little about the molecules regulating vertebrate myocyte fusion, we propose that the mylpfa:H2B-GFP transgene will be a very useful reporter for conducting forward and reverse genetic screens to identify new components regulating vertebrate myocyte fusion.



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Remember 2 Things: When to treat anaphylaxis

Anaphylaxis is a challenging patient presentation. Learn two signs to identify a life-threatening allergic reaction that demands aggressive treatment. If a patient has airway compromise, upper or lower, or signs of shock immediately treat with epinephrine and other protocol-authorized interventions. After watching read more about anaphylaxis assessment and treatment.

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Remember 2 Things: Anaphylaxis and upper airway assessment

Anaphylaxis is a difficult patient presentation. Review two important assessments for upper airway compromise caused by an allergic reaction. Auscultate the patient's trachea and remember facial swelling means upper airway swelling. After watching read more about anaphylaxis assessment and treatment.

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Remember 2 Things: Anaphylaxis and lower airway assessment

Anaphylaxis is a difficult patient presentation. Review two important assessments for lower airway compromise caused by an allergic reaction. Auscultate the patient's lungs for wheezes, starting in the upper lung lobes and listening downward. Also make sure you can distinguish absent lung sounds from clear lung sounds. Finally, remember to listen to lots and lots of lung sounds so you can learn to distinguish normal from abnormal. After watching read more about anaphylaxis assessment and treatment.

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Remember 2 Things: Anaphylaxis and upper airway assessment

Anaphylaxis is a difficult patient presentation. Review two important assessments for upper airway compromise caused by an allergic reaction. Auscultate the patient's trachea and remember facial swelling means upper airway swelling. After watching read more about anaphylaxis assessment and treatment.

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Identification of a founder BRCA1 mutation in the Moroccan population

Abstract

Breast cancer (BC) is the most frequent cancer among women in Morocco. However, the role of the most prevalent BC-predisposing genes, BRCA1 and BRCA2, has been largely unexplored. To help define the role of BRCA1 in breast cancer in Morocco, we characterized the first potential BRCA1 founder mutation in this population. Genetic testing of BRCA1 and BRCA2 in BC high-risk families identified mutation BRCA1 c.5309G>T, p.(Gly1770Val) or G1770V in five independent families from Morocco, suggesting a founder effect. To confirm this hypothesis, haplotype construction was performed using seven intragenic and flanking BRCA1 microsatellite markers. Clinical data were also compiled. Clinical data from carriers of mutation G1770V correspond to data from carriers of BRCA1 pathogenic mutations. Microsatellite analysis showed a common haplotype for the five families in a region comprising 1.54Mb, confirming G1770V as the first specific founder BRCA1 mutation in the Moroccan population.

Our findings contribute to a better understanding of BC genetics in the Moroccan population. Nevertheless, comprehensive studies of mutation G1770V in large series of BC patients from Morocco are needed to assess the real prevalence of this mutation and to improve genetic testing and risk assessment in this population.



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Decision-making for non-invasive prenatal testing for Down syndrome: Hong Kong Chinese women's preferences for individual versus relational autonomy

Abstract

Individual autonomy in antenatal screening is internationally recognised and supported. Policy and practice guidelines in various countries place emphasis on the woman's right to make her own decision and are related to concepts such as self-determination, independence, and self-sufficiency. In contrast, the dominant perspective in Chinese medical ethics suggests that the family is pivotal in making medical decisions, hence providing support for relational autonomy. This study explored Hong Kong Chinese pregnant women's preferences for individual versus relational autonomy for non-invasive prenatal testing (NIPT) for Down syndrome. A qualitative study carried out using semi-structured interviews with 36 women who had undertaken NIPT in Hong Kong. The findings show that most Hong Kong Chinese women valued aspects of both relational and individual autonomy in decision-making for NIPT. Women expected support from doctors as experts on the topic and wanted to involve their husband in decision-making while retaining control over the outcome. Somewhat surprisingly, the findings do not provide support for the involvement of family members in decision-making for NIPT. The adequacy of current interpretations of autonomy in prenatal testing policies as an individual approach needs discussion, where policy developers need to find a balance between individual and relational approaches.



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Remember 2 Things: Understand impact of kinetic energy on MOI

Mechanism of injury, even though its not as important to injury prediction as once believed, is still important for EMS providers to understand. In this episode review the importance of understanding kinetic energy as a cause for traumatic injury. Mass is important, but velocity is even more important. After watching the video test your trauma knowledge with a short quiz on traumatic injury and assessment.

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Is Migration Affecting Prevalence, Awareness, Treatment and Control of Hypertension of Men in Kerala, India?

Abstract

We assessed hypertension prevalence, awareness, treatment and control among male gulf migrant and non-migrant workers in Kerala state of India. We did a cross sectional survey of 191 migrant and 193 non-migrant men aged 25–64 years selected using a multistage random sampling method. Using World Health Organization STEPS approach, we collected information on demographics, STEP 1 variables and measured STEP-2 variables. Multivariate analysis was used to find the relation between migration and hypertension. Age adjusted hypertension prevalence was 57.6 % among migrants and 31.7 % among non-migrants (p < 0.05). Migrants were more likely to be hypertensive (OR 3.00, 95 % CI 1.83–4.94) than non-migrants after adjusting for age, STEP 1 and STEP 2 variables. Though not statistically significant (p = 0.109), awareness of hypertension was lower among migrants (43.5 %) compared to non migrants (56.9 %). Treatment (migrants: 34 %, non-migrants: 53 %, p < 0.05) and control (migrants: 12 %, non-migrants: 48 %, p < 0.001) of hypertension were lower among migrants. Greater attention to improve the treatment and control of hypertension among migrants is warranted in this population.



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Remember 2 Things: Understand impact of kinetic energy on MOI

Mechanism of injury, even though its not as important to injury prediction as once believed, is still important for EMS providers to understand. In this episode review the importance of understanding kinetic energy as a cause for traumatic injury. Mass is important, but velocity is even more important. After watching the video test your trauma knowledge with a short quiz on traumatic injury and assessment.

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