Laboratory investigation of a simulated industrial task pre- and post-ergonomics intervention

The focus of the present study was on the investigation of the effects of an intervention strategy on an industrial task in situ and a simulation of the same task within a laboratory setting. The task of offloading crates from a truck at a local business was simulated in a laboratory setting for rigorous analysis. The effect of an ergonomically sound intervention on selected physical, physiological and perceptual variables was evaluated in a test - retest experimental set-up using 28 young, healthy male students. Each of the two experimental conditions lasted for 16 minutes. In the pre-intervention task subjects were required to transfer the crates from one point to another by sliding them along the floor. During the execution of the post-intervention task responses to reductions in the stacking height and modifications of the working method were evaluated. Results obtained for spinal kinematics during the simulated industrial task indicated a high biomechanical risk, due to large ranges of motion, high velocities and accelerations in the sagittal and transverse planes. The heavy workload of the task was also evident in elevated physiological responses (HR, RF, VT, VE, VO2, RQ, EE) and perceptual ratings (RPE, Body Discomfort). Assessment of the intervention strategy revealed that the high risk industrial task was reduced to moderate acceptable, with measurements of spinal kinematics, physiological and perceptual variables being significantly reduced. An in situ re-assessment of the workers responses to the intervention also elicited reductions in heart rates and perceptual ratings compared to the original task

Spironolactone for adult female acne (SAFA): protocol for a double-blind, placebo-controlled, phase III randomised study of spironolactone as systemic therapy for acne in adult women

Introduction: Acne is one of the most common inflammatory skin diseases worldwide and can have significant psychosocial impact and cause permanent scarring. Spironolactone, a potassium-sparing diuretic, has antiandrogenic properties, potentially reducing sebum production and hyperkeratinisation in acne-prone follicles. Dermatologists have prescribed spironolactone for acne in women for over 30 years, but robust clinical study data are lacking. This study seeks to evaluate whether spironolactone is clinically effective and cost-effective in treating acne in women. Methods and analysis: Women (≥18 years) with persistent facial acne requiring systemic therapy are randomised to receive one tablet per day of 50 mg spironolactone or a matched placebo until week 6, increasing to up to two tablets per day (total of 100 mg spironolactone or matched placebo) until week 24, along with usual topical therapy if desired. Study treatment stops at week 24; participants are informed of their treatment allocation and enter an unblinded observational follow-up period for up to 6 months (up to week 52 after baseline). Primary outcome is the Acne-specific Quality of Life (Acne-QoL) symptom subscale score at week 12. Secondary outcomes include Acne-QoL total and subscales; participant acne self-assessment recorded on a 6-point Likert scale at 6, 12, 24 weeks and up to 52 weeks; Investigator’s Global Assessment at weeks 6 and 12; cost and cost effectiveness are assessed over 24 weeks. Aiming to detect a group difference of 2 points on the Acne-QoL symptom subscale (SD 5.8, effect size 0.35), allowing for 20% loss to follow-up, gives a sample size of 398 participants. Ethics and dissemination: This protocol was approved by Wales Research Ethics Committee (18/WA/0420). Follow-up to be completed in early 2022. Findings will be disseminated to participants, peer-reviewed journals, networks and patient groups, on social media, on the study website and the Southampton Clinical Trials Unit website to maximise impact. Trial registration number ISRCTN12892056;Pre-results

Soziale Unterstützung, interpersonale Probleme, Inanspruchnahme medizinischer Leistungen und postoperative Komplikationen nach aortokoronarer Bypassoperation

This study examines the relationship between psychosocial stress before coronary surgery and the amount of health care utilization during postoperative hospitalization in a sample of 115 patients. The aim of the study is to test the hypothesis that there is a correlation between a high psychosocial stress profile and the utilization of medical care (so called „high utilizers”). The sample consists of 80,9% men and 19,1% women aged between 34 and 78 years. Psychosocial stress was assessed with the following questionnaires: the Survey of Social Support (F-SOZU) and the German version of the Inventory of Interpersonal Problems (IIP-C). An own questionnaire was developed in order to set the somatic parameters. In addition the socio-demographic characteristics, severity of the illness and co-morbidity were ascertained to be used as control variables. The study comes to the following results: Based on the socio-demographic variables and the severity of the illness the subjects are representative for the group of bypass patients. The social stress in the sample is less noticeable not only in respect to the absolute values but also in relationship to control groups. As it has been shown in studies with outpatients, there also exists in the hospital area a group of patients with increased utilization of medical care (so called „high utilizers”). In the study 30% of all the patients utilize 42% of the inpatient time, 45% of all technical examinations, 74% of the medication demand and 100% of all consultations. However, these patients, who show in three to four parameters an increased utilization, don't generally exhibit higher social stress levels. But there are clear tendencies: patients with reduced social support remain on average 2,1 days longer in the hospital, require 1,6 more doses of medication and 1,4 more technical check ups in comparison with patients with higher social support. Furthermore men characterized as „high utilizers” receive significantly less emotional support as men considered to be „low utilizers”. According to the IIP-C those scales which reflect the submissive area correlate for the most part with the utilization of medical care. For example patients exhibiting high utilization in all parameters are defined as being significantly more nonassertive in comparison to patients with average utilization. Between the control variables and the utilization behavior only a few correlations are shown, so that health care utilization is presumably caused by multiple factors

Soziale Unterstützung, interpersonale Probleme, Inanspruchnahme medizinischer Leistungen und postoperative Komplikationen nach aortokoronarer Bypassoperation

This study examines the relationship between psychosocial stress before coronary surgery and the amount of health care utilization during postoperative hospitalization in a sample of 115 patients. The aim of the study is to test the hypothesis that there is a correlation between a high psychosocial stress profile and the utilization of medical care (so called „high utilizers”). The sample consists of 80,9% men and 19,1% women aged between 34 and 78 years. Psychosocial stress was assessed with the following questionnaires: the Survey of Social Support (F-SOZU) and the German version of the Inventory of Interpersonal Problems (IIP-C). An own questionnaire was developed in order to set the somatic parameters. In addition the socio-demographic characteristics, severity of the illness and co-morbidity were ascertained to be used as control variables. The study comes to the following results: Based on the socio-demographic variables and the severity of the illness the subjects are representative for the group of bypass patients. The social stress in the sample is less noticeable not only in respect to the absolute values but also in relationship to control groups. As it has been shown in studies with outpatients, there also exists in the hospital area a group of patients with increased utilization of medical care (so called „high utilizers”). In the study 30% of all the patients utilize 42% of the inpatient time, 45% of all technical examinations, 74% of the medication demand and 100% of all consultations. However, these patients, who show in three to four parameters an increased utilization, don't generally exhibit higher social stress levels. But there are clear tendencies: patients with reduced social support remain on average 2,1 days longer in the hospital, require 1,6 more doses of medication and 1,4 more technical check ups in comparison with patients with higher social support. Furthermore men characterized as „high utilizers” receive significantly less emotional support as men considered to be „low utilizers”. According to the IIP-C those scales which reflect the submissive area correlate for the most part with the utilization of medical care. For example patients exhibiting high utilization in all parameters are defined as being significantly more nonassertive in comparison to patients with average utilization. Between the control variables and the utilization behavior only a few correlations are shown, so that health care utilization is presumably caused by multiple factors

Analysis of cerebral Interleukin-6 and tumor necrosis factor alpha patterns following different ventilation strategies during cardiac arrest in pigs

Hypoxia-induced neuroinflammation after cardiac arrest has been shown to be mitigated by different ventilation methods. In this prospective randomized animal trial, 35 landrace pigs were randomly divided into four groups: intermittent positive pressure ventilation (IPPV), synchronized ventilation 20 mbar (SV 20 mbar), chest compression synchronized ventilation 40 mbar (CCSV 40 mbar) and a control group (Sham). After inducing ventricular fibrillation, basic life support (BLS) and advanced life support (ALS) were performed, followed by post-resuscitation monitoring. After 6 hours, the animals were euthanized, and direct postmortem brain tissue samples were taken from the hippocampus (HC) and cortex (Cor) for molecular biological investigation of cytokine mRNA levels of Interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα). The data analysis showed that CCSV 40 mbar displayed low TNFα mRNA-levels, especially in the HC, while the highest TNFα mRNA-levels were detected in SV 20 mbar. The results indicate that chest compression synchronized ventilation may have a potential positive impact on the cytokine expression levels post-resuscitation. Further studies are needed to derive potential therapeutic algorithms from these findings

Levosimendan Ameliorates Cardiopulmonary Function but Not Inflammatory Response in a Dual Model of Experimental ARDS

The calcium sensitiser levosimendan, which is used as an inodilator to treat decompensated heart failure, may also exhibit anti-inflammatory properties. We examined whether treatment with levosimendan improves cardiopulmonary function and is substantially beneficial to the inflammatory response in acute respiratory response syndrome (ARDS). Levosimendan was administered intravenously in a new experimental porcine model of ARDS. For comparison, we used milrinone, another well-known inotropic agent. Our results demonstrated that levosimendan intravenously improved hemodynamics and lung function in a porcine ARDS model. Significant beneficial alterations in the inflammatory response and lung injury were not detected

Clinical dosage of lidocaine does not impact the biomedical outcome of sepsis-induced acute respiratory distress syndrome in a porcine model

Background Sepsis is a common disease in intensive care units worldwide, which is associated with high morbidity and mortality. This process is often associated with multiple organ failure including acute lung injury. Although massive research efforts have been made for decades, there is no specific therapy for sepsis to date. Early and best treatment is crucial. Lidocaine is a common local anesthetic and used worldwide. It blocks the fast voltage-gated sodium (Na+) channels in the neuronal cell membrane responsible for signal propagation. Recent studies show that lidocaine administered intravenously improves pulmonary function and protects pulmonary tissue in pigs under hemorrhagic shock, sepsis and under pulmonary surgery. The aim of this study is to show that lidocaine inhalative induces equivalent effects as lidocaine intravenously in pigs in a lipopolysaccharide (LPS)-induced sepsis with acute lung injury. Methods After approval of the local State and Institutional Animal Care Committee, to induce the septic inflammatory response a continuous infusion of lipopolysaccharide (LPS) was administered to the pigs in deep anesthesia. Following induction and stabilisation of sepsis, the study medication was randomly assigned to one of three groups: (1) lidocaine intravenously, (2) lidocaine per inhalation and (3) sham group. All animals were monitored for 8 h using advanced and extended cardiorespiratory monitoring. Postmortem assessment included pulmonary mRNA expression of mediators of early inflammatory response (IL-6 & TNF-alpha), wet-to-dry ratio and lung histology. Results Acute respiratory distress syndrome (ARDS) was successfully induced after sepsis-induction with LPS in all three groups measured by a significant decrease in the PaO2/FiO2 ratio. Further, septic hemodynamic alterations were seen in all three groups. Leucocytes and platelets dropped statistically over time due to septic alterations in all groups. The wet-to-dry ratio and the lung histology showed no differences between the groups. Additionally, the pulmonary mRNA expression of the inflammatory mediators IL-6 and TNF-alpha showed no significant changes between the groups. The proposed anti-inflammatory and lung protective effects of lidocaine in sepsis-induced acute lung injury could not be proven in this study

High PEEP Levels during CPR Improve Ventilation without Deleterious Haemodynamic Effects in Pigs

Background: Invasive ventilation during cardiopulmonary resuscitation (CPR) is very complex due to unique thoracic pressure conditions. Current guidelines do not provide specific recommendations for ventilation during ongoing chest compressions regarding positive end-expiratory pressure (PEEP). This trial examines the cardiopulmonary effects of PEEP application during CPR. Methods: Forty-two German landrace pigs were anaesthetised, instrumented, and randomised into six intervention groups. Three PEEP levels (0, 8, and 16 mbar) were compared in high standard and ultralow tidal volume ventilation. After the induction of ventricular fibrillation, mechanical chest compressions and ventilation were initiated and maintained for thirty minutes. Blood gases, ventilation/perfusion ratio, and electrical impedance tomography loops were taken repeatedly. Ventilation pressures and haemodynamic parameters were measured continuously. Postmortem lung tissue damage was assessed using the diffuse alveolar damage (DAD) score. Statistical analyses were performed using SPSS, and p values <0.05 were considered significant. Results: The driving pressure (Pdrive) showed significantly lower values when using PEEP 16 mbar than when using PEEP 8 mbar (p = 0.045) or PEEP 0 mbar (p < 0.001) when adjusted for the ventilation mode. Substantially increased overall lung damage was detected in the PEEP 0 mbar group (vs. PEEP 8 mbar, p = 0.038; vs. PEEP 16 mbar, p = 0.009). No significant differences in mean arterial pressure could be detected. Conclusion: The use of PEEP during CPR seems beneficial because it optimises ventilation pressures and reduces lung damage without significantly compromising blood pressure. Further studies are needed to examine long-term effects in resuscitated animals

Quality and Dose Optimized CT Trauma Protocol - Recommendation from a University Level-I Trauma Center.

Purpose As a supra-regional level-I trauma center, we evaluated computed tomography (CT) acquisitions of polytraumatized patients for quality and dose optimization purposes. Adapted statistical iterative reconstruction [(AS)IR] levels, tube voltage reduction as well as a split-bolus contrast agent (CA) protocol were applied. Materials and Methods 61 patients were split into 3 different groups that differed with respect to tube voltage (120 - 140 kVp) and level of applied ASIR reconstruction (ASIR 20 - 50 %). The CT protocol included a native acquisition of the head followed by a single contrast-enhanced acquisition of the whole body (64-MSCT). CA (350 mg/ml iodine) was administered as a split bolus injection of 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s) with a scan delay of 85 s to detect injuries of both the arterial system and parenchymal organs in a single acquisition. Both the quantitative (SNR/CNR) and qualitative (5-point Likert scale) image quality was evaluated in parenchymal organs that are often injured in trauma patients. Radiation exposure was assessed. Results The use of IR combined with a reduction of tube voltage resulted in good qualitative and quantitative image quality and a significant reduction in radiation exposure of more than 40 % (DLP 1087 vs. 647 mGyxcm). Image quality could be improved due to a dedicated protocol that included different levels of IR adapted to different slice thicknesses, kernels and the examined area for the evaluation of head, lung, body and bone injury patterns. In synopsis of our results, we recommend the implementation of a polytrauma protocol with a tube voltage of 120 kVp and the following IR levels: cCT 5mm: ASIR 20; cCT 0.625 mm: ASIR 40; lung 2.5 mm: ASIR 30, body 5 mm: ASIR 40; body 1.25 mm: ASIR 50; body 0.625 mm: ASIR 0. Conclusion A dedicated adaptation of the CT trauma protocol (level of reduction of tube voltage and of IR) according to the examined body region (head, lung, body, bone) combined with a split bolus CA injection protocol allows for a high-quality CT examination and a relevant reduction of radiation exposure in the examination of polytraumatized patients Key Points  · Dedicated adaption of the CT trauma protocol allows for an optimized examination.. · Different levels of iterative reconstruction, tube voltage and the CA injection protocol are crucial.. · A reduction of radiation exposure of more than 40 % with good image quality is possible.. Citation Format · Kahn J, Kaul D, Böning G et al. Quality and Dose Optimized CT Trauma Protocol - Recommendation from a University Level-I Trauma Center. Fortschr Röntgenstr 2017; 189: 844 - 854

Os números de Catalan e a análise combinatória

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