Efficacy of a certified modular ultrasound curriculum

Background In recent years, ultrasound (US) has become more incorporated into anesthesia and intensive care medicine. The German Anesthesia Society established a modular curriculum to teach US skills. Until now, the efficacy of this modular curriculum has not been validated. Objective The main objective of this study was to determine whether there is an increase of knowledge and of psychomotor skills for the trainees in this curriculum. Material and methods After ethical committee approval, 41 anesthesia physicians were enrolled. To determine the increase of knowledge and of practical skills theoretical and practical tests performed were evaluated before and after two different US courses. Results Comparing before and after course tests, the participants showed significant improvement in theoretical multiple choice tests (p = 0.008). Regarding psychomotor skills following course 1, the trainees improved significantly in the time needed to perform the two practical tests (p = 0.03), but not in the performance of the test. Better needle visualization during simulated US-guided vessel puncture (p = 0.52) and better identification of the anatomical structures in the axillary region (p = 0.56) could not be achieved. Conclusion This study shows that although this US course curriculum has positively enhanced the trainees’ theoretical knowledge of US practice, it does not enhance the practical application of that theoretical knowledge. To improve this curriculum, a supervised clinically practical training should follow the course.Hintergrund Ultraschall (US) hat in den letzten Jahren zunehmend Einzug in die Anästhesie und Intensivmedizin erhalten. Die Deutsche Gesellschaft für Anästhesiologie & Intensivmedizin hat ein modulares Kurssystem zur Vermittlung von US-Kompetenzen entwickelt. Die Wirksamkeit dieses modularen Curriculums wurde bisher nicht validiert. Ziel Ziel dieser Studie war zu ermitteln, ob es bei den Teilnehmern durch den Besuch von Modulen dieses Kurssystems zu einer Verbesserung theoretischer Kenntnisse und praktischer Fertigkeiten kommt. Material und Methode Nach Zustimmung durch die Ethikkommission wurden 41 Anästhesisten in die Studie eingeschlossen. Um den Zugewinn an Wissen und praktischen Fertigkeiten zu ermitteln, wurden theoretische und praktische Tests vor und nach zwei verschiedenen US-Kursen ausgewertet. Ergebnisse Nach den Kursen zeigten die Teilnehmer eine signifikante Verbesserung in den Ergebnissen der Multiple-Choice-Tests (p = 0,008). Hinsichtlich der psychomotorischen Fähigkeiten nach Kurs 1 verbesserten sich die Teilnehmer in der zur Durchführung der beiden praktischen Tests benötigten Zeit signifikant (p = 0,03), nicht aber in der Durchführung der Tests. Die praktischen Aufgaben konnten nach dem Kurs 1 zwar signifikant schneller durchgeführt werden (p = 0,03), die Qualität der Nadelführung (p = 0,52) und die korrekte Benennung anatomischer Strukturen in der Achselregion konnten aber nicht verbessert werden. Schlussfolgerung Diese Studie zeigt, dass obwohl dieses Kurssystem die theoretischen Kenntnisse über die US-Praxis verbessert hat, die praktische Anwendung dieses theoretischen Wissens aber nicht verbessert werden konnten. Um dieses Curriculum zu verbessern, sollte es von einem praktischen Training unter Anleitung ergänzt werden

Lipid peroxidation in multidrug-resistant Gram-negative sepsis: translating science to the septic patient?

Multidrug-resistant Gram-negative induced sepsis poses an increasing threat to the vulnerable intensive care patient. The study by Toufekoula and colleagues reports the serum and tissue concentration of malondialdehyde (MDA), the toxic end product of lipid peroxidation, during the course of experimental and human Gram-negative sepsis. The complementary results from this dual experimental and clinical approach argue for highly compartmentalized lipid peroxidation during sepsis. Establishing a correlation between MDA concentration and survival provides valuable insights into the pathophysiology of Gram-egative sepsis. Yet, further studies are needed to understand and establish MDA as a biomarker during sepsis aggravated by organ failure

IL-36γ/IL-1F9, an innate T-bet target in myeloid cells

Background: The transcription factor T-bet is pivotal for initiation of Th1-related immunoactivation. Identification of novel genes directly regulated by T-bet is crucial. Results: Genome-wide analysis and subsequent experiments revealed that T-bet up-regulates IL-36γ/IL-1F9 in myeloid cells. Conclusion: IL-1-related IL-36γ is a direct T-bet target in myeloid cells. Significance: Observations suggest that IL-36γ , besides IFNγ, contributes to T-bet functions in immunopathology By concerted action in dendritic (DC) and T cells, T-box expressed in T cells (T-bet, Tbx21) is pivotal for initiation and perpetuation of Th1 immunity. Identification of novel T-bet-regulated genes is crucial for further understanding the biology of this transcription factor. By combining siRNA technology with genome-wide mRNA expression analysis, we sought to identify new T-bet-regulated genes in predendritic KG1 cells activated by IL-18. One gene robustly dependent on T-bet was IL-36γ, a recently described novel IL-1 family member. Promoter analysis revealed a T-bet binding site that, along with a κB site, enables efficient IL-36γ induction. Using knock-out animals, IL-36γ reliance on T-bet was extended to murine DC. IL-36γ expression by human myeloid cells was confirmed using monocyte-derived DC and M1 macrophages. The latter model was employed to substantiate dependence of IL-36γ on endogenous T-bet in human primary cells. Ectopic expression of T-bet likewise mediated IL-36γ production in HaCaT keratinocytes that otherwise lack this transcription factor. Additional experiments furthermore revealed that mature IL-36γ has the capability to establish an inflammatory gene expression profile in human primary keratinocytes that displays enhanced mRNA levels for TNFα, CCL20, S100A7, inducible NOS, and IL-36γ itself. Data presented herein shed further light on involvement of T-bet in innate immunity and suggest that IL-36γ, besides IFNγ, may contribute to functions of this transcription factor in immunopathology

Altered renal functions in patients with occlusion of an accessory renal artery after endovascular stenting of an infrarenal aneurysm.

OBJECTIVE Coverage of an accessory renal artery (ARA) during endovascular aneurysm repair (EVAR) may result in renal infarction (RI) or decline in renal function. Until now, it remains vague which patients are at risk to develop these complications. We therefore analyzed the effect of ARA sealing by EVAR with respect to the occurrence of RI and renal function. METHODS A retrospective analysis of the medical records and computed tomographic scans of patients who underwent EVAR within a period of 5 years was performed. Particular attention was paid to the presence or absence of accessory renal arteries and renal function before EVAR. Thirty-four patients with ARA were matched 1:3 to 102 patients without ARA. The results after EVAR were analyzed in patients with and without ARA. In patients with ARA, we further examined the results after EVAR in patients with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min and eGFR < 60 mL/min before EVAR. RESULTS Before EVAR, the median eGFR was 74 mL/min (25th/75th percentiles, 57/89) in patients with ARA and 72 mL/min (25th/75th percentiles, 63/87) in patients without ARA. Alterations in eGFR were significantly pronounced in patients with ARA when compared with patients without ARA 1 week after EVAR (ARA, -10.7 ± 16.9 mL/min vs without ARA, 1.2 ± 13.3 mL/min; P = .002) and after 6 months (ARA, -10.8 ± 17.4 mL/min vs without ARA, 1.2 ± 13.3 mL/min; P = .001). RI only occurred in patients with ARA. Within the group of patients with ARA, patients with normal renal function (NF) showed a more pronounced decline in eGFR preoperatively when compared with patients with impaired renal function (IF) 1 week after EVAR (NF, -14.3 ± 18.0 mL/min vs IF, -1.3 ± 10.8 mL/min; P = .02) and after 6 months (NF, -15.8 ± 17.9 mL/min vs IF, 0.1 ± 15.2 mL/min; P = .007). CONCLUSIONS The decrease in renal function was more pronounced in patients with ARA after EVAR when compared with patients without ARA undergoing EVAR. In patients with ARA, the observed decline in renal function was significantly distinct in patients presenting NF preoperatively. Consequently, the risk of IF after EVAR seems to be increased in patients with ARA and normal preoperative renal function