Clinically stable very low birthweight infants are at risk for recurrent tissue glucose fluctuations even after fully established enteral nutrition

Objective: In previous cases, we have observed occasional hypoglycaemic episodes in preterm infants after initial intensive care. In this prospective study, we determined the frequency and severity of abnormal tissue glucose (TG) in clinically stable preterm infants on full enteral nutrition. Methods: Preterm infants born at <1000 g (n=23; G1) and birth weight 1000–1500 g (n=18; G2) were studied at a postmenstrual age of 32±2 weeks (G1) and 33±2 weeks (G2). Infants were fed two or three hourly, according to a standard bolus-nutrition protocol, and continuous subcutaneous glucose measurements were performed for 72 h. Normal glucose values were assumed at ≥2.5 mmol/L (45 mg/dL) and ≤8.3 mmol/L (150 mg/dL). Frequency, severity and duration of glucose values beyond normal values were determined. Results: We observed asymptomatic low TG values in 39% of infants in G1 and in 44% in G2. High TG values were detected in 83% in G1 and 61% in G2. Infants in G1 experienced prolonged and more severe low TG episodes, and also more frequent and severe high TG episodes. In G1 and G2, 87% and 67% of the infants, respectively, showed glucose fluctuations characterised by rapid glucose increase followed by a rapid glucose drop after feeds. In more mature infants, glucose fluctuations were less pronounced and less dependent on enteral feeds. Conclusions: Clinically stable well-developing preterm infants beyond their initial period of intensive care show interstitial glucose instabilities exceeding values as low as 2.5 mmol/L and as high as 8.3 mmol/L. This novel observation may play an important role for the susceptibility of these high-risk infants for the development of the metabolic syndrome

Impact of Po Valley emissions on the highest glacier of the Eastern European Alps

Abstract. In June 2009, we conducted the first extensive glaciological survey of Alto dell'Ortles, the uppermost glacier of Mt. Ortles (3905 m a.s.l.), the highest summit of the Eastern European Alps. This section of the Alps is located in a rain shadow and is characterized by the lowest precipitation rate in the entire Alpine arc. Mt. Ortles offers a unique opportunity to test deposition mechanisms of chemical species that until now were studied only in the climatically-different western sector. We analyzed snow samples collected on Alto dell'Ortles from a 4.5 m snow-pit at 3830 m a.s.l., and we determined a large suite of trace elements and ionic compounds that comprise the atmospheric deposition over the past two years. Trace element concentrations measured in snow samples are extremely low with mean concentrations at pg g−1 levels. Only Al and Fe present median values of 1.8 and 3.3 ng g−1, with maximum concentrations of 21 and 25 ng g−1. The median crustal enrichment factor (EFc) values for Be, Rb, Sr, Ba, U, Li, Al, Ca, Cr, Mn, Fe, Co, Ga and V are lower than 10 suggesting that these elements originated mainly from soil and mineral aerosol. EFc higher than 100 are reported for Zn (118), Ag (135), Bi (185), Sb (401) and Cd (514), demonstrating the predominance of non-crustal depositions and suggesting an anthropogenic origin. Our data show that the physical stratigraphy and the chemical signals of several species were well preserved in the uppermost snow of the Alto dell'Ortles glacier. A clear seasonality emerges from the data as the summer snow is more affected by anthropogenic and marine contributions while the winter aerosol flux is dominated by crustal sources. For trace elements, the largest mean EFc seasonal variations are displayed by V (with a factor of 3.8), Sb (3.3), Cu (3.3), Pb (2.9), Bi (2.8), Cd (2.1), Zn (1.9), Ni (1.8), Ag (1.8), As (1.7) and Co (1.6). When trace species ratios in local and Po Valley emissions are compared with those in Alto dell'Ortles snow, the deposition on Mt. Ortles is clearly linked with Po Valley summer emissions. Despite climatic differences between the Eastern and Western Alps, trace element ratios from Alto dell'Ortles are comparable with those obtained from high-altitude glaciers in the Western Alps, suggesting similar sources and transport processes at seasonal time scales in these two distinct areas. In particular, the large changes in trace element concentrations both in the Eastern and Western Alps appear to be more related to the regional vertical structure of the troposphere rather than the synoptic weather patterns

Efficacy of a new technique - INtubate-RECruit-SURfactant-Extubate - "IN-REC-SUR-E" - in preterm neonates with respiratory distress syndrome: Study protocol for a randomized controlled trial

Background: Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69&nbsp;%. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an "optimal" functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs. Therefore, the aim of this study is to compare the application of a recruitment maneuver using the high-frequency oscillatory ventilation (HFOV) modality just before the surfactant administration followed by rapid extubation (INtubate-RECruit-SURfactant-Extubate: IN-REC-SUR-E) with IN-SUR-E alone in spontaneously breathing preterm infants requiring nasal continuous positive airway pressure (nCPAP) as initial respiratory support and reaching pre-defined CPAP failure criteria. Methods/design: In this study, 206 spontaneously breathing infants born at 24+0-27+6 weeks' gestation and failing nCPAP during the first 24&nbsp;h of life, will be randomized to receive an HFOV recruitment maneuver (IN-REC-SUR-E) or no recruitment maneuver (IN-SUR-E) just prior to surfactant administration followed by prompt extubation. The primary outcome is the need for mechanical ventilation within the first 3&nbsp;days of life. Infants in both groups will be considered to have reached the primary outcome when they are not extubated within 30&nbsp;min after surfactant administration or when they meet the nCPAP failure criteria after extubation. Discussion: From all available data no definitive evidence exists about a positive effect of recruitment before surfactant instillation, but a rationale exists for testing the following hypothesis: a lung recruitment maneuver performed with a step-by-step Continuous Distending Pressure increase during High-Frequency Oscillatory Ventilation (and not with a sustained inflation) could have a positive effects in terms of improved surfactant distribution and consequent its major efficacy in preterm newborns with respiratory distress syndrome. This represents our challenge. Trial registration: ClinicalTrials.gov identifier: NCT02482766. Registered on 1 June 2015

Spatial variability and potential impacts of climate change on flood and debris flow hazard zone mapping and implications for risk management

The main goals of this study were to identifythe alpine torrent catchments that are sensitive to climatic changes and to assess the robustness of the methods for the elaboration of flood and debris flow hazard zone maps to specific effects of climate changes. In this study, a procedure for the identification and localization of torrent catchments in which the climate scenarios will modify the hazard situation was developed. In two case studies, the impacts of a potential increase of precipitation intensities to the delimited hazard zones were studied. The identification and localization of the torrent and river catchments, where unfavourable changes in the hazard situation occur, could eliminate speculative and unnecessary measures against the impacts of climate changes like a general enlargement of hazard zones or a general over dimensioning of protection structures for the whole territory. The results showed a high spatial variability of the sensitivity of catchments to climate changes. In sensitive catchments, the sediment management in alpine torrents will meet future challenges due to a higher rate for sediment removal from retention basins. The case studies showed a remarkable increase of the areas affected by floods and debris flow when considering possible future precipitation intensities in hazard mapping. But, the calculated increase in extent of future hazard zones lay within the uncertainty of the methods used today for the delimitation of the hazard zones. Thus, the consideration of the uncertainties laying in the methods for the elaboration of hazard zone maps in the torrent and river catchments sensitive to climate changes would provide a useful instrument for the consideration of potential future climate conditions. The study demonstrated that weak points in protection structures in future will become more important in risk management activities

No detrimental effect on renal function during long-term use of fluvastatin in renal transplant recipients in the Assessment of Lescol in Renal Transplantation (ALERT) study

Alert studien er den eneste og den største randomiserte kontrollerte studie hos nyretransplanterte pasienter med nyre og hjertekar hendelser, hvor 2102 pasienter ble fulgt i inntil 8 år. Andelen hjertedød ble redusert med 26% med bruk av det kolesterol senkende middelet fluvastatin. Funnene fra Alert førte til at fluvastatin er blitt rutine behandling hos disse pasienter verden over. Alert materialet er det eneste prospektive materiale som gir mulighet til å vurdere betydningen av potensielle risikofaktorer for disse hendelser. I sin avhandling ”Risikofaktorer for kardiale og renale endepunkter hos nyretransplanterte pasienter” undersøkte Sadollah Abedini og medarbeiderne fire viktige problemstillinger som tidligere ikke er undersøkt hos nyretransplanterte i en prospektiv studie. • Det har vært reist tvil om tryggheten ved statin behandling hos nyre transplanterte mht negativ effekt på transplantat funksjonen. Studien viste at det var trygt å bruke fluvastatin uten negativ virkning på transplantat funksjonen. • Forekomsten og risikofaktorene for slag er også dårlig belyst hos nyretransplanterte. Abedini og medarbeiderne fant at slag forekommer hyppig, og at risikofaktorer varierer i henhold til type slag. • IL-6 og spesielt hsCRP er inflammasjonsmarkører som er etablert risikofaktor for hjertekarsykdom hos ikke-transplanterte, men betydningen hos nyretransplanterte er ukjent. Resultatene fra denne avhandling viser at inflammasjon markørene IL-6 og hsCRP er uavhengig assosiert med hjertekar hendelser og dødelighet. • Asymmetrical DiMethylArginine (ADMA) er en relativ ny aktør som risikofaktor. Studien i denne avhandlingen viser for første gang at ADMA er en uavhengigrisikofaktor for hjertekar hendelser, slag, dødelighet og nedsatt transplantat funksjon hos nyretransplanterte

Does abdominoplasty have a positive influence on quality of life, self-esteem, and emotional stability?

Background: In a previous prospective study, the authors evaluated the quality of life in patients undergoing aesthetic surgery. In this survey, the authors split up the operative indication and analyzed quality of life, self-esteem, and emotional stability after abdominoplasty alone. Methods: Sixty-three patients participated in the study. The testing instrument consisted of a self-developed questionnaire to collect demographic and socioeconomic data and a postoperative complication questionnaire developed especially for abdominoplasties. In addition, a standardized self-assessment test on satisfaction and quality of life (Questions on Life Satisfaction), the Rosenberg Self -Esteem Questionnaire, and the Freiburg Personality Inventory were used. Results: Significantly increasing values in some items of the standardized self-assessment test on satisfaction and quality of life were found: sum scores of the General Life Satisfaction showed a significant improvement (p = 0.004) and the scores of the items housing/living conditions (p = 0.000) and family life/children (p = 0.000). Within the Satisfaction with Health module, a significant improvement in the items mobility (p = 0.02) and independence from assistance (p = 0.01) was found. Values in the module Satisfaction with Appearance (Body Image) increased regarding satisfaction with the abdomen (p = 0.001). Over 84 percent were very satisfied with the aesthetic result, 93.4 percent would undergo the same treatment again, and 88.9 percent would further recommend the operation. Data revealed that participants&apos; self-esteem was very high and their emotional stability was very well balanced. Conclusions: This study demonstrates that abdominoplasty increases most aspects of quality of life, particularly family life, living conditions, mobility, and independency from assistance. Also, patient self-esteem and emotional stability ratings are very high postoperatively. Copyright © 2012 by the American Society of Plastic Surgeons