Diagnosing selective mutism: a critical review of measures for clinical practice and research

Education and Child Studie

Periodic Fluctuation of Tidal Volumes Further Improves Variable Ventilation in Experimental Acute Respiratory Distress Syndrome

In experimental acute respiratory distress syndrome (ARDS), random variation of tidal volumes (VT ) during volume controlled ventilation improves gas exchange and respiratory system mechanics (so-called stochastic resonance hypothesis). It is unknown whether those positive effects may be further enhanced by periodic VT fluctuation at distinct frequencies, also known as deterministic frequency resonance.We hypothesized that the positive effects of variable ventilation on lung functionmay be further amplified by periodic VT fluctuation at specific frequencies. In anesthetized and mechanically ventilated pigs, severe ARDS was induced by saline lung lavage and injurious VT (double-hit model). Animals were then randomly assigned to 6 h of protective ventilation with one of four VT patterns: (1) random variation of VT (WN); (2) P04, main VT frequency of 0.13Hz; (3) P10, main VT frequency of 0.05Hz; (4) VCV, conventional non-variable volume controlled ventilation. In groups with variable VT , the coefficient of variation was identical (30%). We assessed lung mechanics and gas exchange, and determined lung histology and inflammation. Compared to VCV, WN, P04, and P10 resulted in lower respiratory system elastance (63 ± 13 cm H2O/L vs. 50 ± 14 cm H2O/L, 48.4 ± 21 cm H2O/L, and 45.1 ± 5.9 cm H2O/L respectively, P < 0.05 all), but only P10 improved PaO2/FIO2 after 6 h of ventilation (318 ± 96 vs. 445 ± 110mm Hg, P < 0.05). Cycle-by-cycle analysis of lung mechanics suggested intertidal recruitment/de-recruitment in P10. Lung histologic damage and inflammation did not differ among groups. In this experimental model of severe ARDS, periodic VT fluctuation at a frequency of 0.05Hz improved oxygenation during variable ventilation, suggesting that deterministic resonance adds further benefit to variable ventilation

Possibilità di differenziazione degli elettrodi cocleari nelle misurazioni radiologiche della posizione intracocleare e dell'angolo cordo-facciale

Con l'incremento del numero di impianti cocleari effettuati, il controllo di qualità è divenuto sempre più importante. Oltre alle misurazioni biofisiche intraoperatorie ci si può avvalere dell'imaging radiologico. Una nuova tecnica utilizzata in questo campo è il Cone Beam CT (CBCT). Nel presente studio sono stati valutati 65 casi (35 Nucleus Contour AdvanceCochlear; 30 Flex SoftMedEl) studiati mediante CBCT (Accu-I-tomo F17, Morita, Kyoto, Japan). Nello specifico sono stati rilevati: l'angolo di inserzione, l'altezza dell'impianto, la distanza dell'elettrodo dalla parete mediale o laterale, l'angolo tra la corda del timpano e il nervo facciale e la posizione precisa del filo dell'elettrodo nell'angolo cordo-facciale. È stato inoltre possibile valutare la differenza tra il decorso peri-modiolare e laterale degli elettrodi. I dati presentati dimostrano l'accuratezza e il vantaggio della CBCT nella visualizzazione di piccole strutture grazie al ridotto numero di artefatti da indurimento del fascio. Inoltre nel 75% dei pazienti è stato possibile visualizzare l'angolo tra la corda del timpano e il nervo facciale. È stato possibile notare differenze significative fra i vari tipi di elettrodo in funzione del tipo di rapporto con il nervo facciale. In conclusione mediante la CBCT è possibile ottenere una visualizzazione precisa e dettagliate misurazioni della posizione intracocleare dei diversi elettrodi. È persino possibile la corretta valutazione della posizione dell'elettrodo rispetto all'angolo cordo- facciale. La CBCT è quindi, dal nostro punto di vista, un utile strumento per il controllo intra e post-operatorio degli impianti cocleari

Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Background: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. Discussion To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. Trial registration ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1929-0) contains supplementary material, which is available to authorized users

Abstracts from the 8th International Conference on cGMP Generators, Effectors and Therapeutic Implications

This work was supported by a restricted research grant of Bayer AG

Klinische Anwendung eines neuartigen flexiblen Robotersystems in der Behandlung von Läsionen im Bereich des Pharynx und Larynx.

Einleitung: Die transorale Resektion von Tumoren im Bereich des Pharynx und Larynx kann aufgrund der Lokalisation im engen anatomischen Raum anspruchsvoll sein. In dieser Studie wird die transorale Visualisierung und Resektion von Tumoren im Bereich des Pharynx und Larynx mittels eines neuartigen flexiblen Robotersystems evaluiert. Material und Methoden: Das Medrobotics® Flex System ist ein einarmiges, flexibles Robotersystem, das mit 3,5mm flexiblen Instrumenten ausgestattet ist. Bei sieben Patienten wurde eine transorale Resektion von malignen oder benignen Läsionen durchgeführt. Ergebnisse: Eine adäquate Exposition des Befundes wurde in allen Fällen erreicht. Die elektrochirurgische Resektion der Läsion konnte in allen Fällen mit dem Medrobotics® Flex System durchgeführt werden. Die durchschnittliche Dauer zur transoralen Positionierung des Roboters betrug 3,8 ±1,9 min, die durchschnittliche Operationsdauer betrug 8,9 ±4 min. In keinem Fall kam es zu einer postoperativen Komplikation oder Notwendigkeit eines erneuten chirurgischen Eingriffs.. Schlussfolgerung: Mittels des Medrobotics® Flex System ist eine transorale Tumorresektion im Bereich des Pharynx und Larynx klinisch mit guten postoperativen Ergebnis und Funktionserhalt durchführbar. Die gute Visualisierung und Flexibilität stellen Vorteile des Systems dar.Der Erstautor gibt keinen Interessenkonflikt an