How does tube size affect patients’ experiences of postoperative sore throat and hoarseness? A randomised controlled blinded study

Sore throat (POST) and hoarseness (PH) are common complaints after endotracheal intubation (EI). The aim of this study was to investigate whether tube size impacts the experiences of POST and PH after EI in patients undergoing elective surgery, as well as to document a possible role of gender. This randomised, controlled, blinded study was conducted at Aalborg University Hospital, Thisted, Denmark or North Denmark Regional Hospital, Denmark. A total of 236 patients (53.4% female, mean age 50.9 years (SD 14.0)) were enrolled from the departments of gynaecology, parenchyma and orthopaedics. The patients were randomised to a tube size of 8.0 or 7.0 for males and 7.0 or 6.0 for females. Tube sizes were known to the anaesthesia staff but blinded for patients, researchers and staff at the postoperative care unit. POST and/or PH was reported 30–60 min before anaesthesia, at 30 min and at 2, 5, 12, 24, 48, 72 and 96 h after anaesthesia. Both female and male patients experienced significantly lower levels of POST and PH after intubation with the smallest tube size. This study demonstrates that a smaller size of tube results in a reduction in POST and PH after EI for both male and female patients

The Danish Atrial Fibrillation Registry:A Multidisciplinary National Pragmatic Initiative for Monitoring and Supporting Quality of Care Based on Data Retrieved from Administrative Registries

AIM: The Danish Atrial Fibrillation (AF) Registry monitors and supports improvement of quality of care for all AF patients in Denmark. This report describes the registry's administrative and organizational structure, data sources, data flow, data analyses, annual reporting, and feedback between the registry, clinicians, and the administrative system. We also report the selection process of the quality indicators and the temporal trends in results from 2017-2021.METHODS AND RESULTS: The Danish AF Registry aims for complete registration and monitoring of care for all patients diagnosed with AF in Denmark. Administrative registries provide data on contacts to general practice, contacts to private cardiology practice, hospital contacts, medication prescriptions, updated vital status information, and biochemical test results. The Danish Stroke Registry provides information on stroke events. From 2017 to 2021, the proportion with a reported echocardiography among incident AF patients increased from 39.9% (95% CI: 39.3-40.6) to 82.6% (95% CI: 82.1-83.1). The initiation of oral anticoagulant therapy among patients with incident AF and a CHA2DS2-VASc score of ≥1 in men and ≥2 in women increased from 85.3% (95% CI: 84.6-85.9) to 90.4% (95% CI: 89.9-91.0). The 1-year and 2-year persistence increased from 85.2% (95% CI: 84.5-85.9) to 88.7% (95% CI: 88.0-89.3), and from 85.4% (95% CI: 84.7-86.2) to 88.2% (95% CI: 87.5-88.8), respectively. The 1-year risk of ischemic stroke among prevalent patients with AF decreased from 0.88% (95% CI: 0.83-0.93) to 0.71% (95% CI: 0.66-0.75). Variation in clinical performance between the five administrative Danish regions was reduced.CONCLUSION: Continuous nationwide monitoring of quality indicators for AF originating from administrative registries is feasible and supportive of improvements of quality of care.</p

Detection of large deletions in the LDL receptor gene with quantitative PCR methods

BACKGROUND: Familial Hypercholesterolemia (FH) is a common genetic disease and at the molecular level most often due to mutations in the LDL receptor gene. In genetically heterogeneous populations, major structural rearrangements account for about 5% of patients with LDL receptor gene mutations. METHODS: In this study we tested the ability of two different quantitative PCR methods, i.e. Real-Time PCR and Multiplex Ligation-Dependent Probe Amplification (MLPA), to detect deletions in the LDL receptor gene. We also reassessed the contribution of major structural rearrangements to the mutational spectrum of the LDL receptor gene in Denmark. RESULTS: With both methods it was possible to discriminate between one and two copies of the LDL receptor gene exon 5, but the MLPA method was cheaper, and it was far more accurate and precise than Real-Time PCR. In five of 318 patients with an FH phenotype, MLPA analysis revealed five different deletions in the LDL receptor gene. CONCLUSION: The MLPA method was accurate, precise and at the same time effective in screening a large number of FH patients for large deletions in the LDL receptor gene

Genomic characterization of five deletions in the LDL receptor gene in Danish Familial Hypercholesterolemic subjects

BACKGROUND: Familial Hypercholesterolemia is a common autosomal dominantly inherited disease that is most frequently caused by mutations in the gene encoding the receptor for low density lipoproteins (LDLR). Deletions and other major structural rearrangements of the LDLR gene account for approximately 5% of the mutations in many populations. METHODS: Five genomic deletions in the LDLR gene were characterized by amplification of mutated alleles and sequencing to identify genomic breakpoints. A diagnostic assay based on duplex PCR for the exon 7 – 8 deletion was developed to discriminate between heterozygotes and normals, and bioinformatic analyses were used to identify interspersed repeats flanking the deletions. RESULTS: In one case 15 bp had been inserted at the site of the deleted DNA, and, in all five cases, Alu elements flanked the sites where deletions had occurred. An assay developed to discriminate the wildtype and the deletion allele in a simple duplex PCR detected three FH patients as heterozygotes, and two individuals with normal lipid values were detected as normal homozygotes. CONCLUSION: The identification of the breakpoints should make it possible to develop specific tests for these mutations, and the data provide further evidence for the role of Alu repeats in intragenic deletions

In-situ remediation of TCE by ERD in clay tills:Feasibility and performance of full-scale application insights gained through an integrated investigative approach for 2 sites

Background/Objectives. Remediation of trichloroethene (TCE) in clay and other low permeabil-ity geologic media, where groundwater flow occurs preferentially in higher permeability sand lenses or fractures, is a significant challenge. At older sites, much of the contaminant mass is pre-sent as a sorbed phase in the matrix due to matrix diffusion. The principal challenge for in situ remediation in clay is to achieve effective contact between contaminant and bioremediation addi-tives (e.g., organic electron donors and bioaugmentation cultures). The feasibility and perfor-mance of full-scale applications of ERD in clay tills were investigated in a research project in-cluding 2 sites in Denmark undergoing remediation since 2006.Site remediation approach. At the Sortebrovej site an emulsified oil donor (EOS) and a bio-augmentation culture (KB1®) with specific degraders Dehalococcoides were injected in a net-work of screened wells and spread in natural sand stringers embedded in the clay till. At the Gl. Kongevej site organic molasses donor and Bioclear Dechlorinating bioaugmentation culture with specific degraders Dehalococcoides were injected with a drive-point probe (Geoprobe) at 25 cm spaced vertical intervals in the clay till in a closely spaced network. Investigative activities. An integrated investigative approach consisting of water and clay core sample analysis, including stable isotopes and specific degraders, as well as analysis for chlorin-ated solvents, degradation products, donor fermentation products and redox sensitive parameters combined with modelling was applied. Groundwater monitoring of selected wells was performed 2-3 times per year, and very detailed subsampling (on 0.25-5 cm scale) of the intact clay cores for matrix profile analysis was performed after 2 and 4 years. The transport including matrix diffu-sion and degradation in fractures/sand stringers and in bioactive zones in the clay till adjacent to the fractures/sand stringers was modelled to gain insight on the effects of sand stringer/fracture /injection spacing, thickness of bioactive zones, density/numbers of specific degraders, donor longevity, etc., on remediation efficiency and timeframes. Results/Lessons learned. The results showed that the chlorinated solvent TCE was converted into its daughter products (DCE, VC and ethene) but complete conversion of contaminants to ethene (as expected) was not achieved in 4 years. Large variation in the effect of ERD in the clay matrix between sites, boreholes and even between cores was observed. After 4 years, the mass removal at the 2 sites varied between &lt;5% and 50% within the treated zones. The limited effi-ciency of the bioremediation in terms of mass removal is due to the limited spatial extent of dechlorination. If degradation is restricted to narrow bioactive zones of a few cm developing around fractures and sand stringers, contaminants in the remaining part of the matrix are not de-graded and remediation efficiency is low due to the mass transfer limitations. However, the bio-active zones may expand in zones where both donor and chlorinated compounds are present. And in some cores TCE was depleted (degraded to DCE) in zones up to 1.8 m thick, an extent, which could not be explained by diffusive loss to narrow bioactive zones. Hence, biomass migration in the clay matrix appears to play an important role in terms of contaminants mass reduction. <br/