Methods of Administering Superimposed High-Frequency Jet Ventilation and the Associated Risk for Aspiration in a Model of Tracheal Bleeding

Background: To determine the suitability of different superimposed high-frequency jet ventilation (SHFJV) application methods during tracheal bleeding. Objective: To determine the effect of SHFJV on the aspiration of blood during tracheal bleeding. Methods: A test lung was ventilated using SHFJV via a rigid endoscope, a jet laryngoscope and a 4-lumen jet catheter. Packed red blood cells (PRBCs) were injected into the artificial trachea caudally to the rigid endoscope and jet laryngoscope ventilation, and both caudally and cranially during ventilation via the 4-lumen jet catheter, and the migration of PRBCs during ventilation was studied using continuous video recording. Results: Migration of blood into the lower respiratory tract did not occur during SHFJV via the rigid endoscope and jet laryngoscope and via the 4-lumen jet catheter with the bleeding caudal to ventilation source. If the bleeding was cranial to the 4-lumen jet catheter ventilation, migration of blood into the lower respiratory tract was seen when reflux of blood reached the entrainment area. From this area, blood is transported within the jet stream into the lower respiratory tract. Conclusions: SHFJV protects the lower respiratory tract from blood aspiration in case of tracheal bleeding. During SHFJV via the 4-lumen jet catheter, aspiration of blood only occurs if bleeding is localized cranial to the 4-lumen jet catheter ventilation. In case of heavy tracheal bleeding, the jet sources should be positioned cranial to the site of bleeding

Science in Russia: Factors of Modernization and Resources for Development

One of the most strategic resources of a country is its science and technology complex. To be productive, scientists need excellent conditions for doing research. Consequently, they choose such place where they can work efficiently, they even leave their motherland for researching under better conditions. The study describes the key indicators of efficient research activity. To characterize the science of a country, we distinguish two groups: indicators of scientific and technological capabilities and indicators for assessing the impact of scientific productivity. We use statistical data of reports published in Russia from 2003 to 2014. We did the comparative analysis of performance indicators of research activity in some European and Asian OECD member countries. That provides an overview of the main trends of development and the state of world science. Using data analysis presented in Science Watch, Web of Science and Scopus databases, OECD STAN database, ANBERD, the data published by National Science Foundation and the RAND Corporation, we identify key indicators of research activity in the world. We point out the negative tendency of emigration of Russian scientists and highlight the main reasons of this process. In conclusion, we outline the main reasons of the crisis in Russian science

Sind alle Denker traurig? – Fallstudien zum melancholischen Grund des Schöpferischen in Asien und Europa

»Warum erweisen sich alle außergewöhnlichen Männer in Philosophie oder Politik oder Dichtung oder in den Künsten als Melancholiker?« So beginnen die pseudo­ aristotelischen Problemata Physica XXX,1. Die Frage­ form enthält schon die Behauptung, die seit mehr als zwei Jahrtausenden in der abendländischen Tradition scheinbar ungebrochen wiederholt wird und deren vermeintlich kontinuierliche Wirkmacht als bestens er­ forscht gilt. Analysiert man die Genealogie, Medialität und Dynamik dieses Denkbilds vom melancholischen Grund des Schöpferischen jedoch aus morphomatischer Sicht, so ergeben sich bisher kaum beantwortete Fra­ gen: Warum verblasste diese so eindrücklich gestaltete Vorstellung von der Schöpferkraft der Melancholie sofort wieder, und was bewirkte ihre triumphale Wiederkehr in der Renaissance? Wie verhielt es sich mit der tatsäch­ lichen Wirkmacht von Dürers Melencolia I, in Literatur, Bildender Kunst und Philosophie, bevor dieser Kupfer­ stich von den Kunsthistorikern Fritz Saxl und Erwin Panofsky besprochen wurde? Im Abendland wird die Melancholie seit der Renaissance als Genieausweis gehandelt – wie jedoch sieht es in anderen Kulturtradi­ tionen aus? Hat die Melancholie des Schöpferischen ›Schwestern‹ in anderen Weltkulturen? Welche Artefakte, Theorien und Praktiken bezeugen dies? Die Autoren des vorliegenden Bandes gehen diesen und weiteren Fragen in ihren Beiträgen nach, die zu einem Großteil aus Fallstudien bestehen. Sie verhandeln zum einen Hauptmanifestationen der Vorstellung melancho­ lischen Schöpfertums in Europa und setzen zum anderen einen ebenso wichtigen Akzent auf den asiatischen Raum

Safety of percutaneous dilatational tracheotomy (PDT) with the rigid tracheotomy endoscope (TED): a 6-month follow-up multicenter investigation

Background!#!The rigid tracheotomy endoscope (TED) was recently introduced to improve the fiberoptic technique during percutaneous dilatational tracheotomy (PDT) in critically ill patients. The aim was to evaluate the long-term complications of PDT using TED equipment in a prospective multicenter investigation.!##!Methods!#!One hundred eighty adult patients underwent PDT using TED in four German hospitals. Patients who were alive or their guardians were contacted via telephone and interviewed using a structured questionnaire 6 months following the tracheostomy procedure. Patients with airway complaints were invited for outpatient clinical ENT examination. The incidence of adverse events related to PDT was registered.!##!Results!#!Of 180 patients who received tracheostomy, 137 (76.1%) were alive at the time of follow-up. None of the 43 lethal events was related to the PDT. Fifty-three (38.7%) patients were available for follow-up examination, whereas 14 (10.2%) were able to visit ENT physicians. Two (3.8%) out of 53 patients developed tracheocutaneous fistula with required surgical closure of tracheostoma. Dyspnea (7.5%), hoarseness (5.7%), stridor and swallowing difficulties (both with 3.8%) were the most common complaints. Tracheal stenosis was confirmed in 1 patient (1.88% [95% CI: 0.33; 9.93]).!##!Conclusion!#!The use of TED for PDT in the clinical setting is safe regarding adverse events at 6-month follow-up. The incidence of tracheal stenosis after PDT with TED is comparable with that of flexible bronchoscopy; however, its role for PDT at the intensive care unit should be clarified in further investigations

We and our pets: Allergic together?

The study of allergies in creatures living together without being relatives can help us understand the impact of environmental influences. We tested the association of allergies in humans and their pets. A nested unmatched case-control study was performed in a random sample of 4261 inhabitants, aged 25–74 years, of the City of Augsburg, Germany and two adjacent counties. Using standardised computer-assisted face-to-face interviews, we determined and compared the prevalence of doctor-diagnosed atopic diseases (hay fever, asthma, atopic dermatitis) in the study subjects and veterinarian-diagnosed allergies in their pets. Pets were kept in 48.0% of the households (cats 26.1%, dogs 20.1%, rodents 9.7%) and a veterinarian had diagnosed an allergy in 3.9% (cats 3.3%, dogs 4.7%, rodents 1.2%). Atopic diseases were diagnosed in 20.2% of the study subjects (asthma 6.1%, hay fever 13.7%, atopic dermatitis 5.1%). After adjustment for age, sex, parental predisposition and social status a significant association between hay fever in the study subjects and allergies in their pets was observed [odds ratio (OR) 1.74, 95% confidence interval (CI) 1.01–2.97]. This association was more pronounced when investigating dogs only (OR 2.76, 95% CI 1.32–5.77) where in addition an association with the overall prevalence of atopic diseases in the study subjects reached significance (OR 2.31, 95% CI 1.16–4.58). We conclude that there is indication for a concomitant occurrence of allergies in humans and pets. Shared environmental factors are the most likely explanation