Preclinical Ventilation after Drowning

Drowning, being the third leading cause of unintentional accidents leading to death and mainly damaging the respiratory apparatus, demands a quick response and the correct reestablishment of a normal breathing cycle in order to obtain the best possible outcome for rescued patients.Besides the definition of drowning itself and the more complex sub-definitions of submersion, immersion, and non-fatal drowning, this study deals with the onsite treatment as well as the different forms and modes of ventilation in the prehospital setting. It explores the correlation between global drowning statistics, which account for approximately 7% of injury deaths annually with 236 thousand fatalities directly related to drowning or its consequences, and the multiple risk factors and geographical circumstances involved. However, this just implies the total extent of deaths caused by drowning since certain cases remain excluded. It’s nearly impossible to gain a completely objective and overarching overview of the worldwide situation since exact measurements are not possible.Therefore, the estimated number of drowning victims is much higher than statistics show. Correct treatment and aid provided by bystanders or professional first-aiders are important and highly impact the outcome of a drowning accident, which should be as protective and life-sustaining as possible in the long term.According to multiple statistics, the improvement due to endotracheal intubation and mechanical ventilation is capable of minimizing inadequate ventilation by less effective forms of manual ventilation—mouth to mouth, mouth to nose without equipment, with bag valve masks (BVM), or supraglottic airway management—which might even lead to injuries restraining the patient´s rehabilitation

Realistic 3D printed imaging tumor phantoms for validation of image processing algorithms

Medical imaging phantoms are widely used for validation and verification of imaging systems and algorithms in surgical guidance and radiation oncology procedures. Especially, for the performance evaluation of new algorithms in the field of medical imaging, manufactured phantoms need to replicate specific properties of the human body, e.g., tissue morphology and radiological properties. Additive manufacturing (AM) technology provides an inexpensive opportunity for accurate anatomical replication with customization capabilities. In this study, we proposed a simple and cheap protocol to manufacture realistic tumor phantoms based on the filament 3D printing technology. Tumor phantoms with both homogenous and heterogenous radiodensity were fabricated. The radiodensity similarity between the printed tumor models and real tumor data from CT images of lung cancer patients was evaluated. Additionally, it was investigated whether a heterogeneity in the 3D printed tumor phantoms as observed in the tumor patient data had an influence on the validation of image registration algorithms. A density range between -217 to 226 HUs was achieved for 3D printed phantoms; this range of radiation attenuation is also observed in the human lung tumor tissue. The resulted HU range could serve as a lookup-table for researchers and phantom manufactures to create realistic CT tumor phantoms with the desired range of radiodensities. The 3D printed tumor phantoms also precisely replicated real lung tumor patient data regarding morphology and could also include life-like heterogeneity of the radiodensity inside the tumor models. An influence of the heterogeneity on accuracy and robustness of the image registration algorithms was not found

Das SCATTER-Projekt: Computerbasierte Simulation zur Unterstützung bei der strategischen Verlegung von Intensivpatienten [The SCATTER project: computer-based simulation in the strategic transfer of intensive care patients]

Hintergrund: Der Bedarf für ein Konzept für die bundesweite strategische Verlegung von Intensivpatienten wurde durch die COVID-19-Pandemie („coronavirus disease 2019“: Coronavirus-Krankheit-2019; ausgelöst durch eine Infektion mit dem Virus SARS-CoV-2) deutlich. Trotz des eigens hierfür entwickelten Kleeblattkonzeptes stellt die Verlegung einer großen Anzahl von Intensivpatienten eine große Herausforderung dar. Mithilfe einer Computersimulation werden in dem Projekt SCATTER (StrategisChe PATienTenvERlegung) Verlegungsstrategien für die Krisenbewältigung am Beispiel eines fiktiven Szenarios getestet und Empfehlungen entwickelt. Methode: Nach sorgfältiger Erhebung von Prozess- und Strukturdaten für innerdeutsche Intensivtransporte erfolgte die Programmierung der Computersimulation. Hier können auf diverse Parameter Einfluss genommen und unterschiedlichste Verlegungsszenarien erprobt werden. In einem fiktiven Übungsszenario wurden von Schleswig-Holstein ausgehend bundesweite Verlegungen simuliert und anhand verschiedener Kriterien beurteilt. Ergebnisse: Bei den bodengebundenen Verlegungen zeigte sich aufgrund der eingeschränkten Reichweite und in Abhängigkeit der gewählten Zielregion, dass meist nicht alle Patienten verlegt werden können. Luftgebunden lässt sich zwar eine höhere Anzahl von Patienten verlegen, dies ist jedoch oft mit zusätzlichen Umlagerungen verbunden, die ein potenzielles Risiko für die Patienten darstellen. Eine distanzabhängige luft- oder bodengebundene Transportstrategie führte in dem Übungsszenario zu identischen Ergebnissen wie der rein luftgebundene Transport, da aufgrund der großen Distanz stets der luftgebundene Transport gewählt wurde. Diskussion: Aus der Computersimulation können wichtige Erkenntnisse über verschiedene Verlegungsstrategien und Rückschlüsse auf die Realität gezogen und Empfehlungen entwickelt werden

Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013

Background: During weeks 32–33, 2013, 24 cases of cryptosporidiosis were notified in the city of Halle (annual mean 2008–2012: 9 cases). We investigated the outbreak to identify the source and recommend control measures, considering that between weeks 23–25 the river Saale which flows through the city centre overflowed the floodplain, parts of the city centre and damaged sewage systems. Methods: We defined a case as a resident of Halle with gastroenteritis, Cryptosporidium-positive stool and disease onset weeks 27 through 47. In a case–control study among kindergarten children, we compared cases and controls regarding environmental exposure, use of swimming pools, zoo visits and tap water consumption 14 days pre-onset or a corresponding 14-days-period (controls) and adjusted for residence. Stool specimens were tested by microscopy and PCR, and Cryptosporidium DNA was sequenced. Samples from public water system, swimming pools and river Saale were examined for Cryptosporidium oocysts (microscopy and PCR). Results: Overall, 167 cases were detected, 40/167 (24%) were classified as secondary cases. First disease onsets occurred during week 29, numbers peaked in week 34 and started to decrease in week 36. Median age was 8 years (range: 0–77). Compared to controls (n = 61), cases (n = 20) were more likely to report visits to previously flooded areas (OR: 4.9; 95%-CI: 1.4-18) and the zoo (OR: 2.6; 95%-CI: 0.9-7.6). In multivariable analysis visits to the floodplain remained the sole risk factor (OR: 5.5; 95%-CI: 1.4-22). Only C.hominis of a single genotype (IbA9G2) was detected in stools. Oocysts were detected in samples from the river, two local lakes and three public swimming pools by microscopy, but not in the public water supply. Conclusions: Evidence suggests that activities in the dried out floodplain led to infection among children. Secondary transmissions may be involved. Consequently, authorities recommended to avoid playing, swimming and having picnics in the flood-affected area. Health authorities should consider the potential health risks of long-term surviving parasites persisting on flooded grounds and in open waters even several weeks after the flooding and of bathing places close to sewage spill-overs. Preventive measures comprise water sampling (involving parasites), information of the public and prolonged closures of potentially contaminated sites

Automated Non-Contact Respiratory Rate Monitoring of Neonates Based on Synchronous Evaluation of a 3D Time-of-Flight Camera and a Microwave Interferometric Radar Sensor

This paper introduces an automatic non-contact monitoring method based on the synchronous evaluation of a 3D time-of-flight (ToF) camera and a microwave interferometric radar sensor for measuring the respiratory rate of neonates. The current monitoring on the Neonatal Intensive Care Unit (NICU) has several issues which can cause pressure marks, skin irritations and eczema. To minimize these risks, a non-contact system made up of a 3D time-of-flight camera and a microwave interferometric radar sensor is presented. The 3D time-of-flight camera delivers 3D point clouds which can be used to calculate the change in distance of the moving chest and from it the respiratory rate. The disadvantage of the ToF camera is that the heartbeat cannot be determined. The microwave interferometric radar sensor determines the change in displacement caused by the respiration and is even capable of measuring the small superimposed movements due to the heartbeat. The radar sensor is very sensitive towards movement artifacts due to, e.g., the baby moving its arms. To allow a robust vital parameter detection the data of both sensors was evaluated synchronously. In this publication, we focus on the first step: determining the respiratory rate. After all processing steps, the respiratory rate determined by the radar sensor was compared to the value received from the 3D time-of-flight camera. The method was validated against our gold standard: a self-developed neonatal simulation system which can simulate different breathing patterns. In this paper, we show that we are the first to determine the respiratory rate by evaluating the data of an interferometric microwave radar sensor and a ToF camera synchronously. Our system delivers very precise breaths per minute (BPM) values within the norm range of 20–60 BPM with a maximum difference of 3 BPM (for the ToF camera itself at 30 BPM in normal mode). Especially in lower respiratory rate regions, i.e., 5 and 10 BPM, the synchronous evaluation is required to compensate the drawbacks of the ToF camera. In the norm range, the ToF camera performs slightly better than the radar sensor

Inhibition of Adhesion, Proliferation, and Invasion of Primary Endometriosis and Endometrial Stromal and Ovarian Carcinoma Cells by a Nonhyaluronan Adhesion Barrier Gel

Endometriosis is a chronic disease of women in the reproductive age, defined as endometrial cells growing outside of the uterine cavity and associated with relapses. Relapses are hypothesized to correlate with incomplete surgical excision or result from nonrandom implantation of new endometrial implants in adjacent peritoneum. Thus, surgical excision could lead to free endometriotic cells or tissue residues, which readhere, grow, and invade into recurrent lesions. Barrier agents are frequently used to prevent postoperative adhesions. We tested if the absorbable cell adhesion barrier gel Intercoat consisting of polyethylene oxide and sodium carboxymethyl cellulose could inhibit cellular adhesion, proliferation, and invasion of primary endometriosis and endometrial cells. Due to an association of endometriosis with ovarian carcinoma, we tested two ovarian carcinoma cell lines. Prior to cell seeding, a drop of the barrier gel was placed in cell culture wells in order to test inhibition of adherence and proliferation or coated over a polymerized collagen gel to assay for prevention of invasion. Results showed that the barrier gel significantly inhibited cell adherence, proliferation, and invasion of endometriosis and endometrial stromal cells as well as ovarian carcinoma cells in culture. Our findings could help to prevent local cell growth/invasion and possible consequent recurrences

Correlation of histological and macroscopic findings in peritoneal endometriosis

Context: In the last two decades, a color based concept of disease activity in peritoneal endometriosis has been in use in the clinical context, with red lesions being considered active and black or white lesions being interpreted as less active or dormant. Objective: Our aim was to analyze 4 main color categories of peritoneal endometriosis (black, white, red and brown) in one single patient group using histomorphological and immunohistochemical methods. Design: 65 endometriosis lesions (30 black, 17 white, 11 brown, 7 red) were resected from 47 premenopausal, nulliparous women which had not received exogenous hormones for at least six months prior to the operation. Specimen workup, histomorphological analysis and immunohistochemical analysis were performed in a standardized manner. Results: The color categories showed a broad overlap in proliferative activity and hormone receptor expression. Differences were found in lesion morphology. Adjacent stromal reaction in particular showed a marked increase from red through brown and black to white lesions. Differences were also seen in gland pattern and gland content. Conclusions: Lesion colors in peritoneal endometriosis seem to be determined by gland content and a varying adjacent stromal reaction and more likely reflect an aging process than different levels of disease activity

RETRACTED ARTICLE: Improving usability and pregnancy rates of a fertility monitor by an additional mobile application: results of a retrospective efficacy study of Daysy and DaysyView app

Abstract Background Daysy is a fertility monitor that uses the fertility awareness method by tracking and analyzing the individual menstrual cycle. In addition, Daysy can be connected to the application DaysyView to transfer stored personal data from Daysy to a smartphone or tablet (IOS, Android). This combination is interesting because as it is shown in various studies, the use of apps is increasing patients´ focus on their disease or their health behavior. The aim of this study was to investigate if by the additional use of an App and thereby improved usability of the medical device, it is possible to enhance the typical-use related as well as the method-related pregnancy rates. Result In the resultant group of 125 women (2076 cycles in total), 2 women indicated that they had been unintentionally pregnant during the use of the device, giving a typical-use related Pearl-Index of 1.3. Counting only the pregnancies which occurred as a result of unprotected intercourse during the infertile (green) phase, we found 1 pregnancy, giving a method-related Pearl-Index of 0.6. Calculating the pregnancy rate resulting from continuous use and unprotected intercourse exclusively on green days, gives a perfect-use Pearl-Index of 0.8. Conclusion It seems that combining a specific biosensor-embedded device (Daysy), which gives the method a very high repeatable accuracy, and a mobile application (DaysyView) which leads to higher user engagement, results in higher overall usability of the method

Additional file 1: of Improving usability and pregnancy rates of a fertility monitor by an additional mobile application: results of a retrospective efficacy study of Daysy and DaysyView app

The questionnaire. (DOCX 61 kb