11 research outputs found
Emergency front-of-neck access in infants: A pragmatic crossover randomized control trial comparing two approaches on a simulated rabbit model.
BACKGROUND
Rapid-sequence tracheotomy and scalpel-bougie tracheotomy are two published approaches for establishing emergency front-of-neck access in infants. It is unknown whether there is a difference in performance times and success rates between the two approaches.
AIMS
The aim of this cross-over randomized control trial study was to investigate whether the two approaches were equivalent for establishing tracheal access in rabbit cadavers. The underlying hypothesis was that the time to achieve the tracheal access is the same with both techniques.
METHODS
Between May and September 2022, thirty physicians (pediatric anesthesiologists and intensivists) were randomized to perform front-of-neck access using one and then the other technique: rapid-sequence tracheotomy and scalpel-bougie tracheotomy. After watching training videos, each technique was practiced four times followed by a final tracheotomy during which study measurements were obtained. Based on existing data, an equivalence margin was set at ââ=â±10âs for the duration of the procedure. The primary outcome was defined as the duration until tracheal tube placement was achieved successfully. Secondary outcomes included success rate, structural injuries, and subjective participant self-evaluation.
RESULTS
The median duration of the scalpel-bougie tracheotomy was 48âs (95% CI: 37-57), while the duration of the rapid-sequence tracheotomy was 59âs (95% CI: 49-66, pâ=â.07). The difference in the median duration between the two approaches was 11âs (95% CI: -4.9 to 29). The overall success rate was 93.3% (95% CI: 83.8%-98.2%). The scalpel-bougie tracheotomy resulted in significantly fewer damaged tracheal rings and was preferred among participants.
CONCLUSIONS
The scalpel-bougie tracheotomy was slightly faster than the rapid-sequence tracheotomy and favored by participants, with fewer tracheal injuries. Therefore, we propose the scalpel-bougie tracheostomy as a rescue approach favoring the similarity to the adult approach for small children. The use of a comparable equipment kit for both children and adults facilitates standardization, performance, and logistics.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT05499273
Bewertung der Vor- und Nachteile von Wasserstoffimporten im Vergleich zur heimischen Erzeugung - Update : Studie fĂŒr den Landesverband Erneuerbare Energien NRW e.V. (LEE-NRW)
Deutschlands Klimaschutzstrategie baut auf den Einsatz von grĂŒnem Wasserstoff aus erneuerbaren Energien. Doch wo soll der Wasserstoff herkommen, aus heimischer Produktion oder importiert aus dem Ausland? Eine Studie des Wuppertal Instituts und DIW Econ schafft einen Ăberblick ĂŒber die aktuelle Datenlage und ermittelt Wertschöpfungs- und BeschĂ€ftigungseffekte beider Strategien. Das ResĂŒmee: Es trifft nicht zu, dass importierter Wasserstoff allgemein gĂŒnstiger ist, entscheidend sind je nach Herkunftsland die tatsĂ€chlich realisierbaren Strom- und Transportkosten. Wird der grĂŒne Wasserstoff stattdessen im eigenen Land produziert, wird dies zudem eine positive BeschĂ€ftigungswirkung und Wertschöpfung entfalten. Mit der Erreichung der Klimaziele 2050 betrĂŒge die zusĂ€tzliche Wertschöpfung bei einer stark auf die heimische Erzeugung ausgerichtete Strategie bis zu 30 Milliarden Euro im Jahr 2050 und es könnten bis zu 800.000 ArbeitsplĂ€tze geschaffen werden
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Functional redundancy between RAP1 isoforms in murine platelet production and function
RAP GTPases, important regulators of cellular adhesion, are abundant signaling
molecules in the platelet/megakaryocytic lineage. However, mice lacking the predominant isoform, RAP1B, display a partial platelet integrin activation defect and have a normal platelet count, suggesting the existence of a RAP1-independent pathway to integrin activation in platelets and a negligible role for RAP GTPases in megakaryocyte biology. To determine the importance of individual RAP isoforms on platelet production and on platelet activation at sites of mechanical injury or vascular leakage, we conditionally deleted Rap1a and/or Rap1b in the megakaryocytic lineage (mKO). Interestingly, Rap1a/b-mKO mice displayed a marked macrothrombocytopenia due to impaired pro- platelet formation by megakaryocytes. In platelets, RAP isoforms had both redundant and
isoform-Ëspecific functions. Deletion of RAP1B, but not RAP1A, significantly reduced α- granule secretion and activation of the cytoskeleton regulator RAC1. Both isoforms significantly contributed to thromboxane A2 generation and the inside-out activation of platelet integrins. Combined deficiency of RAP1A and RAP1B markedly impaired platelet aggregation, spreading and clot retraction. Consistently, thrombus formation in physiological flow conditions was abolished in Rap1a/b-mKO, but not Rap1a-mKO or Rap1b-mKO platelets. Rap1a/b-mKO mice were strongly protected from experimental thrombosis and exhibited a severe defect in hemostasis after mechanical injury. Surprisingly, Rap1a/b-mKO platelets were indistinguishable from controls in their ability to prevent blood-lymphatic mixing during development and hemorrhage at sites of inflammation.
In summary, our studies demonstrate an essential role for RAP1 signaling in platelet
integrin activation and a critical role in platelet production. While important for
hemostatic/thrombotic plug formation, platelet RAP1 signaling is dispensable for vascular integrity during development and inflammation
The critical cysteine in the gastric H, K ATPase for inhibition of acid secretion by proton pump inhibitors
Inflammation-induced emergency megakaryopoiesis driven by hematopoietic stem cell-like megakaryocyte progenitors
Infections are associated with extensive platelet consumption, representing a high risk for health. However, the mechanism coordinating the rapid regeneration of the platelet pool during such stress conditions remains unclear. Here, we report that the phenotypic hematopoietic stem cell (HSC) compartment contains stem-like megakaryocyte-committed progenitors (SL-MkPs), a cell population that shares many features with multipotent HSCs and serves as a lineage-restricted emergency pool for inflammatory insults. During homeostasis, SL-MkPs are maintained in a primed but quiescent state, thus contributing little to steady-state megakaryopoiesis. Even though lineage-specific megakaryocyte transcripts are expressed, protein synthesis is suppressed. In response to acute inflammation, SL-MkPs become activated, resulting in megakaryocyte protein production from pre-existing transcripts and a maturation of SL-MkPs and other megakaryocyte progenitors. This results in an efficient replenishment of platelets that are lost during inflammatory insult. Thus, our study reveals an emergency machinery that counteracts life-threatening platelet depletions during acute inflammation