Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial

Succinylcholine and rocuronium are widely used to facilitate rapid sequence induction (RSI) intubation in intensive care. Concerns relate to the side effects of succinylcholine and to slower onset and inferior intubation conditions associated with rocuronium. So far, succinylcholine and rocuronium have not been compared in an adequately powered randomized trial in intensive care. Accordingly, the aim of the present study was to compare the incidence of hypoxemia after rocuronium or succinylcholine in critically ill patients requiring an emergent RSI

Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

Objective. To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis (RAP) of 30-74 minutes before skin incision compared to the World Health Organization (WHO) standard of 0-60 minutes. Design. Prospective study on timing of routine antimicrobial prophylaxis in 2 different time periods. Setting. Tertiary referral university hospital with 30,000 surgical procedures per year. Methods. In all consecutive vascular, visceral, and trauma procedures, the timing was prospectively recorded during a first time period of 2 years (A; baseline) and a second period of 1 year (B; after intervention). An intensive intervention program was initiated after baseline. The primary outcome parameter was timing; the secondary outcome parameter was surgical site infection (SSI) rate in the subgroup of patients undergoing cholecystectomy/colon resection. Results. During baseline time period A (3,836 procedures), RAP was administered 30-74 minutes before skin incision in 1,750 (41.0%) procedures; during time period B (1,537 procedures), it was administered in 914 (56.0%; P < .001). The subgroup analysis did not reveal a significant difference in SSI rate. Conclusions. This bundle of interventions resulted in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO standar

Co-infection of Influenza B and Streptococci causing severe pneumonia and septic shock in healthy women

<p>Abstract</p> <p>Background</p> <p>Since the Influenza A pandemic in 1819, the association between the influenza virus and <it>Streptococcus pneumoniae </it>has been well described in literature. While a leading role has been so far attributed solely to Influenza A as the primary infective pathogen, Influenza B is generally considered to be less pathogenic with little impact on morbidity and mortality of otherwise healthy adults. This report documents the severe synergistic pathogenesis of Influenza B infection and bacterial pneumonia in previously healthy persons not belonging to a special risk population and outlines therapeutic options in this clinical setting.</p> <p>Case Presentation</p> <p>During the seasonal influenza epidemic 2007/2008, three previously healthy women presented to our hospital with influenza-like symptoms and rapid clinical deterioration. Subsequent septic shock due to severe bilateral pneumonia necessitated intensive resuscitative measures including the use of an interventional lung assist device. Microbiological analysis identified severe dual infections of Influenza B with <it>Streptococcus pyogenes </it>in two cases and <it>Streptococcus pneumoniae </it>in one case. The patients presented with no evidence of underlying disease or other known risk factors for dual infection such as age (< one year, > 65 years), pregnancy or comorbidity.</p> <p>Conclusions</p> <p>Influenza B infection can pose a risk for severe secondary infection in previously healthy persons. As patients admitted to hospital due to severe pneumonia are rarely tested for Influenza B, the incidence of admission due to this virus might be greatly underestimated, therefore, a more aggressive search for influenza virus and empirical treatment might be warranted. While the use of an interventional lung assist device offers a potential treatment strategy for refractory respiratory acidosis in addition to protective lung ventilation, the combined empiric use of a neuraminidase-inhibitor and antibiotics in septic patients with pulmonary manifestations during an epidemic season should be considered.</p

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Low pressure chemical vapour deposition of ZnO layers for thin-film solar cells: temperature-induced morphological changes

Zinc oxide (ZnO) is now often used as a transparent conductive oxide for contacts in thin-film silicon solar cells. This paper presents a study of ZnO material deposited by the low-pressure chemical vapour deposition technique, in a pressure range below the pressures usually applied for the deposition of this kind of material. A temperature series has been deposited, showing a morphological transition around 150 °C. ZnO samples deposited with temperatures just higher than this transition are constituted of large grains highly oriented along a single crystallographic orientation. These “monocrystals” lead to low resistivity values, showing a clear correlation between the size of the surface grains and the electrical performance of corresponding films. Additionally, these large grains also yield ZnO layers with high transparency and high light-scattering power, specially suitable for solar cell technology based on thin-film silicon

[Perioperative management of chronic medication: to withhold, continue or intensify?]

All patients should undergo surgical procedures in the most stable and favourable condition with a continuation of chronic medication. Accordingly, this medication should be continued until the day before surgery in most patients. The preoperative period should be used to evaluate the completeness and quality of the medical treatment. Are all patient with cardiological indications for beta-receptor blocking agents, ACE-inhibitors and statins treated with these drugs? Is diabetes being adequately treated? Are the doses of the medication for the treatment of thyroid dysfunction within the optimal range? If there is room for improvement, adjustments should be done cautiously and well in advance. In contrast, there are no recognised situations in which a medication should be started preoperatively in the absence of a pre-established chronic indication. Management of antiplatelet agents and cumarins requires careful consideration. The hazards of continuing and withholding treatment must be evaluated. In patients who have suffered a cardiovascular event and/or have undergone (coronary) revascularisation, elective surgery must be delayed for weeks or months depending on the circumstances and the devices used

Thinking Outside the Box: The Museum Haus Konstruktiv Collection (1986–2016) and Guest Interventions

The year 2016 is an important one for Museum Haus Konstruktiv: celebrating the 30th anniversary. To mark this occasion, the constantly growing collection shall be acknowledged in the extensive group exhibition “Thinking Outside the Box”. In this exhibition, they deliberately avoid using external loaned items and concentrate on works from the collection. The selection was made from over 900 works, more than 100 of which have been added since the last major anniversary year, 2011. The exhibition intends to focus, in particular, on these new additions and on the historical legacy of several key figures in constructivist-concrete art. In the “guest interventions”, they will position the selected exhibits of the collection within the echo chamber of contemporary art. This includes various artistic strategies and media (video, performance, painting, sculpture and conceptual text/image works) that produce contextual shifts and breaking points, and which can be seen as humorous and subversive commentary

Additional file 1 of Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study

Additional file 1. Online data supplement

Apple whole genome sequences: recent advances and new prospects

Genetics: Apple genome sequencing begins to bear fruit Almost 10 years since the first draft of the apple genome was published, the insights it has afforded are being used to improve crops, while next generation DNA sequencing is enabling the breeding value of individual plants to be more rapidly assessed. In this review, Cameron Peace at Washington State University in Pullman, US, and colleagues describe the impact whole genome sequencing of the Golden Delicious apple has had on our understanding of how cultivated apples evolved, and the genomic regions controlling fruit firmness and flavor, tree growth dynamics, responses to water and nutrient availability, and other such traits. These early discoveries have also paved the way for trait-predictive tests which should further accelerate the breeding of improved apple trees, and epigenetic studies to better understand how environmental factors trigger heritable changes in apple characteristics