Microbiological evaluation of different reprocessing methods for cuffed and un-cuffed tracheostomy tubes in home-care and hospital setting

Background: Manufacturers’ recommendations on cleaning of tracheostomy tubes focus on general warning information and non-specific manual cleaning procedures. The aim of this experimental study was to evaluate different reprocessing methods and to determine the mechanical integrity and functionality of tracheostomy tubes following reprocessing. Methods: Sixteen cuffed or un-cuffed tracheostomy tubes obtained from hospital in-patients were reprocessed using one of the following reprocessing methods: a) manual brushing and rinsing with tap water, b) manual brushing followed by disinfection with a glutaraldehyde solution, c) manual brushing followed machine-based cleaning in a dishwasher, and d) manual brushing followed by ultrasound cleaning in a commercially available ultrasound device. Microbial burden of the tubes before and after reprocessing was assessed by measurement of microbial colony-forming units per mL (CFU/mL) of rinsing fluid. After cleaning, tracheostomy tubes were investigated for loss of functionality. Findings: Manual brushing and rinsing with tap water reduced microbial colonization in average by 102 CFU/mL, but with poor reproducibility and reliability. Complete microbial reduction was achieved only with additional chemical or machine-based thermal disinfection. Ultrasound sonification yielded no further microbial reduction after manual brushing. Conclusion: Manual brushing alone will not result in complete eradication of microorganism colonising cuffed or un-cuffed tracheostomy tubes. However, manual cleaning followed by chemical or thermal disinfection may be regarded as safe and reproducible reprocessing method. If a machine-based reprocessing method is used for cuffed tubes, the cuffs’ ventilation hose must be secured in a safe position prior to thermal disinfection

Scientific cruise report Elisabeth Mann-Borgese SUMMIX-MESO

Objectives: It was intended to investigate the meso-scale and sub-meso-scale dynamics of the upper layers (upper 80 m) in the central Baltic Sea, using towed instruments and acoustic profilers, to better understand the physical conditions for cyanobacteria blooms. Under optimal weather conditions, we intended to carry out 10 one-day quasi-synoptic surveys by cruising in large meandering patterns (see fig. 1) covering areas of 15 X 15 nautical miles or 8 X 8 nautical miles, depending on the survey mode, see below. This cruise was the meso-scale component of the two-ship SUMMIX experiment together with RV Meteor (Physical and biochemical exchange-, mixing- and transformation processes in the central Baltic Sea during summer stratification and their controls on the cyanobacterial summer bloom) which was intended to be located at a fixed position nearby RV Elisabeth Mann Borgese in order to survey the water column in high vertical, spatial and parameter resolution, including biogeochemical experiments on board. In addition to the physical parameters, also vertical and horizontal zooplankton net tows as well as water samples taken by CTD bottles were planned

The antimicrobial effect of Octenidine-dihydrochloride coated polymer tracheotomy tubes on Staphylococcus aureus and Pseudomonas aeruginosa colonisation

<p>Abstract</p> <p>Background</p> <p>The surface of polymeric tracheotomy tubes is a favourable environment for biofilm formation and therefore represents a potential risk factor for the development of pneumonia after tracheotomy. The aim of this <it>in-vitro </it>study was to develop octenidine-dihydrochloride (OCT) coated polymer tracheotomy tubes and investigate any effects on <it>Staphylococcus (S.) aureus </it>and <it>Pseudomonas (P.) aeruginosa </it>colonization. Additionally the resistance of the OCT coating was tested using reprocessing procedures like brushing, rinsing and disinfection with glutaraldehyde</p> <p>Results</p> <p><it>Contamination with S. aureus</it>: Before any reprocessing, OCT coated tracheotomy tubes were colonized with 10³cfu/ml and uncoated tracheotomy tubes with 10⁵cfu/ml (P = 0.045). After reprocessing, no differences in bacterial concentration between modified and conventional tubes were observed.</p> <p><it>Contamination with P. aeruginosa</it>: Before reprocessing, OCT coated tubes were colonized with 10⁶cfu/ml and uncoated tubes with 10⁷cfu/ml (P = 0.006). After reprocessing, no significant differences were observed.</p> <p>Conclusion</p> <p>OCT coating initially inhibits <it>S. aureus </it>and <it>P. aeruginosa </it>colonisation on tracheotomy tubes. This effect, however, vanishes quickly after reprocessing of the tubes due to poor adhesive properties of the antimicrobial compound. Despite the known antimicrobial effect of OCT, its use for antimicrobial coating of tracheotomy tubes is limited unless methods are developed to allow sustained attachment to the tube.</p

Glycemic index and microstructure analysis of a newly developed fiber enriched cookie

A diet with a high glycemic index (GI) is associated with an elevated risk for obesity or type 2 diabetes. We investigated the GI of a newly-developed fiber enriched cookie and characterized the microstructure of ingredients used. In a study with 26 non-diabetic healthy volunteers it was shown that the fiber enriched cookie has a GI of 58.9 in relation to white bread as reference. Using a conversion factor of 1.4, the GI of the fiber enriched cookie in relation to a glucose-solution is 42.0 and can be classified as a low-GI food. Postprandial insulin concentration was significantly lower after consumption of fiber enriched cookies compared to white bread. Glucose release after in vitro digestion was significantly lower from fiber enriched cookies compared to other cookies tested. In addition to its high percentage of fiber, the cookies’ low GI can be attributed to the limited gelatinization potential of the starch granules found in the ingredients used. Using confocal laser scanning microscopy it is shown that starch granule surface area of whole grain barley flour, spelt flour and oat flakes bears cluster-shaped protein–NSPS complexes that preferentially absorb water in conditions of water shortage and thereby prevent starch gelatinization

Human Papillomavirus prevalence and probable first effects of vaccination in 20 to 25 year-old women in Germany: a population-based cross-sectional study via home-based self-sampling

BACKGROUND: Estimates of Human Papillomavirus (HPV) prevalence in a population prior to and after HPV vaccine introduction are essential to evaluate the short-term impact of vaccination. METHODS: Between 2010 and 2012 we conducted a population-based cross-sectional study in Germany to determine HPV prevalence, genotype distribution and risk factors for HPV-infection in women aged 20-25 years. Women were recruited by a two-step cluster sampling approach. A home-based self-collection of cervicovaginal lavages was used. Specimens were analysed using a general primer GP5+/GP6+-based polymerase chain reaction and genotyped for 18 high-risk and 6 low-risk HPV- strains by Luminex-based multiplexed genotyping. RESULTS: Among 787 included women, 512 were not vaccinated against HPV. In the non-vaccinated population, HPV prevalence of any type was 38.1%, with HPV 16 (19.5%) being the most prevalent genotype. Prevalence of any high-risk type was 34.4%, and in 17.4% of all women, more than one genotype was identified. A higher number of lifetime sexual partners and low educational status were independently associated with HPV-infection. In 223 vaccinated women, prevalence of HPV 16/18 was significantly lower compared to non-vaccinated women (13.9% vs. 22.5%, p = 0.007). When stratifying by age groups, this difference was only significant in women aged 20-21 years, who at time of vaccination were on average younger and had less previous sexual contacts than women aged 22-25 years. CONCLUSION: We demonstrate a high prevalence of high-risk HPV genotypes in non-vaccinated women living in Germany that can be potentially prevented by vaccination. Probable first vaccination effects on the HPV prevalence were observed in women who were vaccinated at younger age. This finding reinforces the recommendation to vaccinate girls in early adolescence

Reionization with galaxies and active galactic nuclei

In this work we investigate the properties of the sources that reionized the intergalactic medium (IGM) in the high-redshift Universe. Using a semi-analytical model aimed at reproducing galaxies and black holes in the first 1.5 Gyr of the Universe, we revisit the relative role of star formation and black hole accretion in producing ionizing photons that can escape into the IGM. Both star formation and black hole accretion are regulated by supernova feedback, resulting in black hole accretion being stunted in low-mass halos. We explore a wide range of combinations for the escape fraction of ionizing photons (redshift-dependent, constant and scaling with stellar mass) from both star formation ($\langle f_{\rm esc}^{\rm sf} \rangle$) and AGN ($f_{\rm esc}^{\rm bh}$) to find: (i) the ionizing budget is dominated by stellar radiation from low stellar mass ($M_*6$ with the AGN contribution (driven by $M_{bh}>10^6 {\rm M_\odot}$ black holes in $M_* > 10^9 {\rm M_\odot}$ galaxies) dominating at lower redshifts; (ii) AGN only contribute $10-25\%$ to the cumulative ionizing emissivity by $z=4$ for the models that match the observed reionization constraints; (iii) if the stellar mass dependence of $\langle f_{\rm esc}^{\rm sf} \rangle$ is shallower than $f_{\rm esc}^{\rm bh}$, at $z<7$ a transition stellar mass exists above which AGN dominate the escaping ionizing photon production rate; (iv) the transition stellar mass decreases with decreasing redshift. While AGN dominate the escaping emissivity above the knee of the stellar mass function at $z \sim 6.8$, they take-over at stellar masses that are a tenth of the knee mass by $z=4$.Comment: Accepted to MNRA

An Intraoral OCT Probe to Enhanced Detection of Approximal Carious Lesions and Assessment of Restorations

Caries, the world’s most common chronic disease, remains a major cause of invasive restorative dental treatment. To take advantage of the diagnostic potential of optical coherence tomography (OCT) in contemporary dental prevention and treatment, an intraorally applicable spectral-domain OCT probe has been developed based on an OCT hand-held scanner equipped with a rigid 90°-optics endoscope. The probe was verified in vitro. In vivo, all tooth surfaces could be imaged with the OCT probe, except the vestibular surfaces of third molars and the proximal surface sections of molars within a 'blind spot' at a distance greater than 2.5 mm from the tooth surface. Proximal surfaces of 64 posterior teeth of four volunteers were assessed by intraoral OCT, visual-tactile inspection, bitewing radiography and fiber-optic transillumination. The agreement in detecting healthy and carious surfaces varied greatly between OCT and established methods (18.2–94.7%), whereby the established methods could always be supplemented by OCT. Direct and indirect composite and ceramic restorations with inherent imperfections and failures of the tooth-restoration bond were imaged and qualitatively evaluated. The intraoral OCT probe proved to be a powerful technological approach for the non-invasive imaging of healthy and carious hard tooth tissues and gingiva as well as tooth-colored restorations

COX-2 mRNA Expression is Significantly Increased in Acid-exposed Compared to Nonexposed Squamous Epithelium in Gastroesophageal Reflux Disease

Background: Little is known about the role of cyclooxygenase (COX)-2 in gastroesophageal reflux disease (GERD) and the development of Barrett's metaplasia. The objectives of this study were to further analyze COX-2 mRNA expression in patients with GERD compared to Barrett's esophagus (BE) and Barrett's cancer (BC). Methods: Tissue samples from 110 patients with GERD (n = 43), BE (n = 20), and BC (n = 47) were obtained in routine upper GI endoscopy. Expression levels of COX-2 were measured by quantitative real-time reverse trancriptase polymerase chain reaction (RT-PCR). Also, 24-h pH monitoring was performed in all patients of the GERD study group and the DeMeester composite score was used to match COX-2 mRNA expression with the severity of acid exposure in the lower esophagus. Results: COX-2 mRNA is progressively upregulated within the metaplasia-dysplasia-adenocarcinoma (MDA) sequence (p = 0.001). COX-2 levels of the squamous epithelium in the distal esophagus from patients with GERD and a pathologic mean DeMeester score (>14.72) were significantly higher than in patients with normal DeMeester scores (p = 0.01). Conclusion: In summary our findings suggest that alterations in COX-2 mRNA expression occur independently of endoscopic or histologic signs of GERD in the acid-exposed squamous epithelium of the distal esophagus. However, this early COX-2 increase in GERD is further upregulated within the MDA sequence for yet unknown reason

Checklist on the quality of the repetitive peripheral magnetic stimulation (rPMS) methods in research: An international Delphi study

An increasing number of clinical research studies have used repetitive peripheral magnetic stimulation (rPMS) in recent years to alleviate pain or improve motor function. rPMS is non-invasive, painless, and administrated over peripheral nerve, spinal cord roots, or a muscle using a coil affixed to the skin and connected to a rapid-rate magnetic stimulator. Despite the clinical impact and scientific interest, the methodological inconsistencies or incomplete details and findings between studies could make the rPMS demonstration difficult to replicate. Given the lack of guidelines in rPMS literature, the present study aimed at developing a checklist to improve the quality of rPMS methods in research. An international panel of experts identified among those who had previously published on the topic were enrolled in a two-round web-based Delphi study with the aim of reaching a consensus on the items that should be reported or controlled in any rPMS study. The consensual rPMS checklist obtained comprises 8 subject-related items (e.g., age, sex), 16 methodological items (e.g., coil type, pulse duration), and 11 stimulation protocol items (e.g., paradigm of stimulation, number of pulses). This checklist will contribute to new interventional or exploratory rPMS research to guide researchers or clinicians on the methods to use to test and publish rPMS after-effects. Overall, the checklist will guide the peer-review process on the quality of rPMS methods reported in a publication. Given the dynamic nature of a consensus between international experts, it is expected that future research will affine the checklist