Factors associated with laryngeal injury after intubation in children:a systematic review

Purpose: The purpose of this study is to evaluate all potential factors associated with laryngeal injury after endotracheal intubation in the pediatric population. Methods: A systematic literature search was conducted in Medline, Embase, Cochrane, web of science and Google scholar up to 20th of March 2023. We included all unique articles focusing on factors possibly associated with intubation-injury in pediatric patients. Two independent reviewers determined which articles were relevant by coming to a consensus, quality of evidence was rated using GRADE criteria. All articles were critically appraised according to the PRISMA guidelines. The articles were categorized in four outcome measures: post-extubation stridor, post-extubation upper airway obstruction (UAO) necessitating treatment, laryngeal injury found at laryngoscopy and a diagnosed laryngotracheal stenosis (LTS). Results: A total of 24 articles with a total of 15.520 patients were included. The incidence of post-extubation stridor varied between 1.0 and 30.3%, of post-extubation UAO necessitating treatment between 1.2 and 39.6%, of laryngeal injury found at laryngoscopy between 34.9 to 97.0% and of a diagnosed LTS between 0 and 11.1%. Although the literature is limited and quality of evidence very low, the level of sedation and gastro-esophageal reflux are the only confirmed associated factors with post-extubation laryngeal injury. The relation with age, weight, gender, duration of intubation, multiple intubations, traumatic intubation, tube size, absence of air leak and infection remain unresolved. The remaining factors are not associated with intubation injury. Conclusion: We clarify the role of the potential factors associated with laryngeal injury after endotracheal intubation in the pediatric population.</p

Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors.

All gynecologists are faced with ovarian tumors on a regular basis, and the accurate preoperative diagnosis of these masses is important because appropriate management depends on the type of tumor. Recently, the International Ovarian Tumor Analysis (IOTA) consortium published the Assessment of Different NEoplasias in the adneXa (ADNEX) model, the first risk model that differentiates between benign and four types of malignant ovarian tumors: borderline, stage I cancer, stage II-IV cancer, and secondary metastatic cancer. This approach is novel compared to existing tools that only differentiate between benign and malignant tumors, and therefore questions may arise on how ADNEX can be used in clinical practice. In the present paper, we first provide an in-depth discussion about the predictors used in ADNEX and the ability for risk prediction with different tumor histologies. Furthermore, we formulate suggestions about the selection and interpretation of risk cut-offs for patient stratification and choice of appropriate clinical management. This is illustrated with a few example patients. We cannot propose a generally applicable algorithm with fixed cut-offs, because (as with any risk model) this depends on the specific clinical setting in which the model will be used. Nevertheless, this paper provides a guidance on how the ADNEX model may be adopted into clinical practice

Migration aspirations and migration cultures:A case study of Ukrainian migration towards the European Union

An abundant body of research focused on macrolevel, mesolevel, and microlevel factors explaining why individuals move across international borders. In this paper, we aim to complement the existing literature by exploring how, within a single country, mesolevel factors differently impact migration aspirations, focusing on a case study of Ukraine. We particularly focus on how migration aspirations of individuals in two different regions can be explained by their international social networks with family members, on the one hand, and with friends, on the other. Furthermore, we explore whether regional migration characteristics play a role, as well as the interaction of such characteristics with individuals' frequency of contact with transnational networks. Our analyses are based on the EUMAGINE project and suggest that the interplay between regional migration characteristics and transnational social contact are key for explainingthe decline of migration systems over time

National differences in screening programmes for cardiovascular risks could obstruct understanding of cardiovascular prevention studies in Europe

Introduction In North-West Europe, cardiovascular disease is still a major cause of death and despite several efforts (e.g. European guidelines and conferences) cardiovascular risk factors are still inconsistently diagnosed and treated. Methods We evaluated the first consultations of patients in two cardiovascular referral clinics in France and the Netherlands, while evaluating the differences in national guidelines and between the profiles of patients at their first consultation. Results Notable differences exist between the two locally used guidelines in their programmes of cardiovascular risk assessment and their definition of LDL-cholesterol target levels. With regard to the LDL-cholesterol levels, more patients are 'on target' when using the French guideline than when using the Dutch guideline. Evaluation of the patient's profile at first presentation showed that the LDL-cholesterol levels were significantly lower in the Dutch patients (n=77) compared with the French patients (n=119). Dutch patients used significantly more statins than French patients. Conclusion Despite the small study population included in this study, we found that comparison of daily care (as part of a primary prevention programme) is rather difficult due to several national differences in the approach to patients. All these factors combined should be taken into account, when discussing and extrapolating results obtained from analysis of cardiovascular prevention programmes

Post-extubation stridor after prolonged intubation in the pediatric intensive care unit (PICU): a prospective observational cohort study

Purpose: Prolonged endotracheal intubation may lead to laryngeal damage, with stridor being the most relevant clinical symptom. Our objective was to determine the incidence of post-extubation stridor and their clinical consequences in children within a tertiary referral center and to identify contributing factors. Methods: 150 children, aged 0–16 years, intubated for more than 24 h were prospectively enrolled until discharge of the hospital. Potential relevant factors, thought to mediate the risk of laryngeal damage, were recorded and analyzed. Results: The median duration of intubation was 4 days, ranging from 1 to 31 days. Stridor following extubation occurred in 28 patients (18.7%); 3 of them required reintubation due t

Regulation of inhibin βB-subunit mRNA expression in rat Sertoli cells: Consequences for the production of bioactive and immunoreactive inhibin

Abstract In Sertoli cells from 21-day-old rats, the expression of the mRNA encoding the α-subunit of inhibin, and the production of immunoreactive inhibin are stimulated by follicle-stimulating hormone (FSH). In contrast, the amount of βB-subunit mRNA is not increased after FSH treatment of the cells, and the ratio between bioactive and immunoactive inhibin decreases after stimulation with FSH. These data suggest that the βB-subunit is the limiting factor in the production of bioactive inhibin. The aim of the present experiments was to investigate the effect of changes in the amount of βB-subunit mRNA on the production of bioactive and immunoreactive inhibin. During early postnatal testicular development, the relative amounts of the 4.2 kb and 3.5 kb mRNAs encoding the βB-subunit of inhibin changed markedly. The meaning of this changing ratio between βB-subunit mRNAs is not clear, since both mRNAs are actively translated, as demonstrated by polysomal analysis. The total amount of βB-subunit mRNA correlated with the in vitro production of bioactive inhibin as published earlier. Prolonged stimulation of cultured Sertoli cells from 14-day-old rats with 4β-phorbol 12-myristate 13-acetate (PMA) caused a decreased expression of the βB-subunit mRNAs, presumably by down-regulation of protein kinase C. A similar effect was obtained after addition of the calcium ionophore A23187. Concomitantly, a decreased production of bioactive inhibin was observed. Furthermore, Western blotting revealed that secretion of the 32 kDa inhibin αβ-dimer was decreased, whereas secretion of the combination of the C-terminal part with the pro-region of the α-subunit was increased. It is concluded that the level of the βB-subunit of inhibin is rate-limiting for the production of bioactive inhibin in cultured Sertoli cells, and that its expression can be influenced by modulation of protein kinase C, and/or intracellular calcium levels

Cross-Comparison of Climate Change adaptation Strategies Across Large River Basins in Europe, Africa and Asia

A cross-comparison of climate change adaptation strategies across regions was performed, considering six large river basins as case study areas. Three of the basins, namely the Elbe, Guadiana, and Rhine, are located in Europe, the Nile Equatorial Lakes region and the Orange basin are in Africa, and the Amudarya basin is in Central Asia. The evaluation was based mainly on the opinions of policy makers and water management experts in the river basins. The adaptation strategies were evaluated considering the following issues: expected climate change, expected climate change impacts, drivers for development of adaptation strategy, barriers for adaptation, state of the implementation of a range of water management measures, and status of adaptation strategy implementation. The analysis of responses and cross-comparison were performed with rating the responses where possible. According to the expert opinions, there is an understanding in all six regions that climate change is happening. Different climate change impacts are expected in the basins, whereas decreasing annual water availability, and increasing frequency and intensity of droughts (and to a lesser extent floods) are expected in all of them. According to the responses, the two most important drivers for development of adaptation strategy are: climate-related disasters, and national and international policies. The following most important barriers for adaptation to climate change were identified by responders: spatial and temporal uncertainties in climate projections, lack of adequate financial resources, and lack of horizontal cooperation. The evaluated water resources management measures are on a relatively high level in the Elbe and Rhine basins, followed by the Orange and Guadiana. It is lower in the Amudarya basin, and the lowest in the NEL region, where many measures are only at the planning stage. Regarding the level of adaptation strategy implementation, it can be concluded that the adaptation to climate change has started in all basins, but progresses rather slowl