Efficacy of modified Tochen’s formula for optimum endotracheal tube placement in low birth weight neonates- an RCT

<div>Abstract:</div><div>Objective: To study the effectiveness of modified Tochen’s formula (hereafter known as the alternative formula) when compared to Tochen’s formula for optimal placement of endotracheal tubes in LBW neonates.</div><div>Study Design: A randomized controlled trial conducted in 70 neonates. Neonates requiring intubation for ventilation, with a confirmatory chest radiograph, were included in the study. They were intubated using Tochen’s formula (birth weight in kg + 6cm) or Alternative formula (birth weight in kg + 5cm). Tube tip placement was verified and modified, if necessary, after auscultation. The incidence of inadequate placement and optimum length of ET insertion were estimated from the chest radiographs. Incidence of adverse events in the two groups were noted.</div><div>Results: A total number of 92 babies were eligible for the study. One family refused consent and twenty-one families could not be approached and hence not included in study. A total of 70 neonates were randomized and included in the study; 34 in Tochen’s group and 33 in alternative formula group. Baseline characteristics between the two groups had no statistically significant differences (p->0.05).</div><div>Measurements in the alternative formula group were significantly (p - 0.006) closer to the optimal position (distance from optimum - 0.50 cm ± 0.41) when compared to Tochen’s group (distance from optimum - 0.86 cm ± 0.06) The adverse events were significantly (p- 0.005) greater in the group that was intubated using Tochen’s formula (16 of 34, 47.05%) when compared to the group where the alternative formula was applied (5 of 33, 15.15%). Though the percentage of optimum (8 of 33, 24.24%) and adequate placements (29 of 33, 87.87%) of the ET tube was higher in the group of the alternative formula when compared to the optimal (3 of 34, 8.82%) and adequate placement (24 of 34, 70.58%) of ET tube in the Tochen’s group, this was not statistically significant (p- >0.05). The depth of ET placement was found to be overestimated in the Tochen’s group as compared to the group of the alternative formula</div><div>Conclusion: The incidence of adequate and optimal placement of ET tube was higher in alternative formula group and the distance from optimal was significantly smaller when compared to the Tochen’s group. The adverse events were significantly fewer in the alternative formula group. Hence, the use of the alternative formula in low birth weight babies may enable the more accurate placement of ET tubes in low birth weight babies when compared to the Tochen’s formula.</div><div><br></div

<b>Understanding Providers’ Readiness and Attitudes Toward Autoantibody Screening: A Mixed-Methods Study</b>

Screening for autoantibodies associated with type 1 diabetes can identify people most at risk for progressing to clinical type 1 diabetes and can provide an opportunity for early intervention. Drawbacks and barriers to screening exist, and concerns arise, as methods for disease prevention are limited and no cure exists today. The availability of novel treatment options such as teplizumab to delay progression to clinical type 1 diabetes in high-risk individuals has led to the reassessment of screening programs. This study explored awareness, readiness, and attitudes of endocrinology providers toward type 1 diabetes autoantibody screening.</p

Allelic association of <i>IL13</i> SNPs with chronic and late-stage <i>S</i>. <i>japonicum infection</i>.

<p>Allelic association of <i>IL13</i> SNPs with chronic and late-stage <i>S</i>. <i>japonicum infection</i>.</p

IL-13 protein was determined by IHC and western blot.

<p>(A) Representative images of normal liver tissues and <i>S</i>.<i>japonicum</i>-induced fibrotic liver tissues (Images were captured at 100x and 400x with scale bar of 100 μm). (B) Comparison of scores of ST2 staining intensity betwee <i>S</i>. <i>japonicum</i>-induced fibrotic liver tissues and normal liver tissues. (C) IL-13 protein was detected in liver tissue lysates by western blots.</p

General characteristics of <i>IL13</i> SNPs in Chines study samples.

<p>* From hg19.</p><p>General characteristics of <i>IL13</i> SNPs in Chines study samples.</p

An IL-13 Promoter Polymorphism Associated with Liver Fibrosis in Patients with <i>Schistosoma japonicum</i>

<div><p>The aim of this study was to determine whether two polymorphisms in the gene encoding <i>IL13</i> previously associated with <i>Schistosoma hematobium</i> (<i>S</i>. <i>hematobium</i>) and <i>S</i>. <i>mansoni</i> infection are associated with <i>S</i>. <i>japonicum</i> infection. Single nucleotide polymorphisms (SNPs) rs1800925 (IL13/-1112C>T) and rs20541 (IL13R130Q) were genotyped in 947 unrelated individuals (307 chronically infected, 339 late-stage with liver fibrosis, 301 uninfected controls) from a schistosomiasis-endemic area of Hubei province in China. Regression models were used to evaluate allelic and haplotypic associations with chronic and late-stage schistosomiasis adjusted for non-genetic covariates. Expression of IL-13 was measured in <i>S</i>. <i>japonicun</i>-infected liver fibrosis tissue and normal liver tissue from uninfected controls by immunohistochemistry (IHC). The role of rs1800925 in IL-13 transcription was further determined by Luciferase report assay using the recombinant PGL4.17-rs180092 plasmid. We found SNP rs1800925T was associated with late-stage schistosomiasis caused by <i>S</i>. <i>japonicum</i> but not chronic schistosomiasis (OR = 1.39, 95%CI = 1.02–1.91, p = 0.03) and uninfected controls (OR = 1.49, 95%CI = 1.03–2.13, p = 0.03). Moreover, the haplotype rs1800925T-rs20541C increased the risk of disease progression to late-stage schistosomiasis (OR = 1.46, p = 0.035), whereas haplotype rs1800925C-rs20541A showed a protective role against development of late-stage schistosomiasis (F = 0.188, OR = 0.61, p = 0.002). Furthermore, <i>S</i>. <i>japonicum</i>-induced fibrotic liver tissue had higher IL13 expression than normal liver tissue. Plasmid PGL4.17-rs1800925T showed a stronger relative luciferase activity than Plasmid PGL4.17-rs1800925C in 293FT, QSG-7701 and HL-7702 cell lines. In conclusion, the functional <i>IL13</i> polymorphism, rs1800925T, previously associated with risk of schistosomiasis, also contributes to risk of late-stage schistosomiasis caused by <i>S</i>. <i>japonicum</i>.</p></div

Haplotypic association of <i>IL13</i> SNPs with chronic and late-stage <i>S</i>. <i>japonicum</i> infection.

<p>F1, frequency of controls; F2, frequency of chronic cases; F3, frequency of late-stage cases.</p><p>Haplotypic association of <i>IL13</i> SNPs with chronic and late-stage <i>S</i>. <i>japonicum</i> infection.</p

Relative luciferase activity of plasmid construct of PGL4.17-rs1800925T and PGL4.17-rs1800925C in 293FT, QSG-7701 and HL-7702 cell lines.

<p>(A) Complementary base sequence of target DNA in plasmid PGL4.17-rs1800925C. (B) Complementary base sequence of target DNA in plasmid PGL4.17-rs1800925T constructed by overlap PCR. (C) Relative luciferase activity of plasmid construct of PGL4.17-rs1800925T and PGL4.17-rs1800925C in 293FT, QSG-7701 and HL-7702 cell lines. (Rs1800925C indicates plasmid PGL4.17-rs1800925C and rs1800925T indicates plasmid PGL4.17-rs1800925T).</p