Long-term neuromuscular sequelae of critical illness

In this observational study, we analyzed the long-term neuromuscular deficits of survivors of critical illness. Intensive care unit-acquired muscular weakness (ICU-AW) is a very common complication of critical illness. Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) are two main contributors to ICU-AW. ICU-AW is associated with an increased mortality and leads to rehabilitation problems. However, the long-term outcome of ICU-AW and factors influencing it are not well known. We analyzed the medical records of 490 survivors of critical illness, aged 18-75years and located in the area of the study center. Intensive care unit (ICU) survivors with comorbidities that might influence neuromuscular follow-up examinations, muscle strength, or results of nerve conduction studies, such as renal or hepatic insufficiency, diabetes mellitus, or vitamin deficiency were excluded. A total of 51 patients were finally included in the study. Six to 24months after discharge from the ICU, we measured the Medical Research Council (MRC) sum score, the Overall Disability Sum score (ODSS), and also performed nerve conduction studies and EMG. For all ICU survivors, the median MRC sum score was 60 (range 47-60) and the median ODSS score was 0 (range 0-8). CIP was diagnosed in 21 patients (41%). No patient was diagnosed with CIM. Patients with diagnosis of CIP showed a higher median ODSS scores 1 (range 0-8) versus 0 (range 0-5); p<0.001 and lower median MRC sum scores 56 (range 47-60) versus 60 (range 58-60); p<0.001. The three main outcome variables MRC sum score, ODSS score and diagnosis of CIP were not related to age, gender, or diagnosis of sepsis. The MRC sum score (r=−0.33; p=0.02) and the ODSS score (r=0.31; p=0.029) were correlated with the APACHE score. There was a trend for an increased APACHE score in patients with diagnosis of CIP 19 (range 6-33) versus 16.5 (range 6-28); p=0.065. Patients with the diagnosis of CIP had more days of ICU treatment 11days (range 2-74) versus 4days (range 1-61); p=0.015, and had more days of ventilator support 8days (range 1-59) versus 2days (range 1-46); p=0.006. The MRC sum score and the ODSS score were correlated with the days of ICU treatment and with the days of ventilator support. The neuromuscular long-term consequences of critical illness were not severe in our study population. As patients with concomitant diseases and old patients were excluded from this study the result of an overall favorable prognosis of ICU-acquired weakness may not be true for other patient's case-mix. Risk factors for the development of long-term critical illness neuropathy are duration of ICU treatment, duration of ventilator support, and a high APACHE score, but not diagnosis of sepsis. Although ICU-AW can be serious complication of ICU treatment, this should not influence therapeutic decisions, given its favorable long-term prognosis, at least in relatively young patients with no concomitant disease

Multiobjective Optimization of Laser Polishing of Additively Manufactured Ti-6Al-4V Parts for Minimum Surface Roughness and Heat-Affected Zone

Metal parts produced by additive manufacturing often require postprocessing to meet the specifications of the final product, which can make the process chain long and complex. Laser post-processes can be a valuable addition to conventional finishing methods. Laser polishing, specifically, is proving to be a great asset in improving the surface quality of parts in a relatively short time. For process development, experimental analysis can be extensive and expensive regarding the time requirement and laboratory facilities, while computational simulations demand the development of numerical models that, once validated, provide valuable tools for parameter optimization. In this work, experiments and simulations are performed based on the design of experiments to assess the effects of the parametric inputs on the resulting surface roughness and heat-affected zone depths. The data obtained are used to create both linear regression and artificial neural network models for each variable. The models with the best performance are then used in a multiobjective genetic algorithm optimization to establish combinations of parameters. The proposed approach successfully identifies an acceptable range of values for the given input parameters (laser power, focal offset, axial feed rate, number of repetitions, and scanning speed) to produce satisfactory values of Ra and HAZ simultaneously

Effect of process parameters on surface texture generated by laser polishing of additively manufactured Ti-6Al-4V

Although there have been numerous attempts to define how different laser polishing parameters affect the generated surface roughness, there has been no detailed investigation of how their effects can be combined to optimize the process. This paper applies statistical analysis to model and predict the resulting surface roughness for laser post-processing of components made of Ti-6Al-4V and produced by laser powder bed fusion. This model is based on analysis of a wide ranging experimental programme investigating how the interaction of the governing parameters, i.e., laser power, number of repetitions, axial feed rate, scanning speed, and focal position, affected surface roughness. The experimental programme was the result of a robust Design of Experiments analysis and experimental analysis using ANOVA. It is expected that the outcomes will contribute towards the understanding of how the governing parameters influence the laser polishing process and final surface roughness, and would be a tool for optimizing their selection. The results of the ANOVA (analysis of variance) revealed that the most significant parameters are scanning speed followed by laser power and then axial feed rate. In addition, a clear tendency for the estimated Ra to decrease with the increase in laser power at lower values of axial feed rate and of scanning speed, and a focal position in the region of 2 mm. It is noted that the process parameters were varied over wide ranges, including extreme values, which made it difficult to accurately model the dependent variable over the full range of experimental trials

Two-Step Laser Post-Processing for the Surface Functionalization of Additively Manufactured Ti-6Al-4V Parts

Laser powder bed fusion (LPBF) is one of the additive manufacturing methods used to build metallic parts. To achieve the design requirements, the LPBF process chain can become long and complex. This work aimed to use dierent laser techniques as alternatives to traditional post-processes, in order to add value and new perspectives on applications, while also simplifying the process chain. Laser polishing (LP) with a continuous wave laser was used for improving the surface quality of the parts, and an ultrashort pulse laser was applied to functionalize it. Each technique, individually and combined, was performed following distinct stages of the process chain. In addition to removing asperities, the samples after LP had contact angles within the hydrophilic range. In contrast, all functionalized surfaces presented hydrophobicity. Oxides were predominant on these samples, while prior to the second laser processing step, the presence of TiN and TiC was also observed. The cell growth viability study indicated that any post-process applied did not negatively aect the biocompatibility of the parts. The presented approach was considered a suitable post-process option for achieving dierent functionalities in localized areas of the parts, for replacing certain steps of the process chain, or a combination of both

Efficiency of biofilm removal by combination of water jet and cold plasma: an in-vitro study

Background: Peri-implantitis therapy is a major problem in implantology. Because of challenging rough implant surface and implant geometry, microorganisms can hide and survive in implant microstructures and impede debridement. We developed a new water jet (WJ) device and a new cold atmospheric pressure plasma (CAP) device to overcome these problems and investigated aspects of efficacy in vitro and safety with the aim to create the prerequisites for a clinical pilot study with these medical devices. Methods: We compared the efficiency of a single treatment with a WJ or curette and cotton swab (CC) without or with adjunctive use of CAP (WJ + CAP, CC + CAP) to remove biofilm in vitro from rough titanium discs. Treatment efficacy was evaluated by measuring turbidity up to 72 h for bacterial re-growth or spreading of osteoblast-like cells (MG-63) after 5 days with scanning electron microscopy. With respect to application safety, the WJ and CAP instruments were examined according to basic regulations for medical devices. Results: After 96 h of incubation all WJ and CC treated disks were turbid but 67% of WJ + CAP and 46% CC + CAP treated specimens were still clear. The increase in turbidity after WJ treatment was delayed by about 20 h compared to CC treatment. In combination with CAP the cell coverage significantly increased to 82% (WJ + CAP) or 72% (CC + CAP), compared to single treatment 11% (WJ) or 10% (CC). Conclusion: The newly developed water jet device effectively removes biofilm from rough titanium surfaces in vitro and, in combination with the new CAP device, biologically acceptable surfaces allow osteoblasts to grow. WJ in combination with CAP leads to cleaner surfaces than the usage of curette and cotton swabs with or without subsequent plasma treatment. Our next step will be a clinical pilot study with these new devices to assess the clinical healing process

Seasonal Occurrence and Carbapenem Susceptibility of Bovine Acinetobacter baumannii in Germany

Acinetobacter baumannii is one of the leading causes of nosocomial infections in humans. To investigate its prevalence, distribution of sequence types (STs), and antimicrobial resistance in cattle, we sampled 422 cattle, including 280 dairy cows, 59 beef cattle, and 83 calves over a 14-month period. Metadata, such as the previous use of antimicrobial agents and feeding, were collected to identify putative determining factors. Bacterial isolates were identified via MALDI-TOF/MS and PCR, antimicrobial susceptibility was evaluated via VITEK2 and antibiotic gradient tests, resistance genes were identified by PCR. Overall, 15.6% of the cattle harbored A. baumannii, predominantly in the nose (60.3% of the A. baumannii isolates). It was more frequent in dairy cows (21.1%) than in beef cattle (6.8%) and calves (2.4%). A seasonal occurrence was shown with a peak between May and August. The rate of occurrence of A. baumannii was correlated with a history of use of 3rd generation cephalosporins in the last 6 months prior to sampling Multilocus sequence typing (Pasteur scheme) revealed 83 STs among 126 unique isolates. Nine of the bovine STs have previously been implicated in human infections. Besides known intrinsic resistance of the species, the isolates did not show additional resistance to the antimicrobial substances tested, including carbapenems. Our data suggest that cattle are not a reservoir for nosocomial A. baumannii but carry a highly diverse population of this species. Nevertheless, some STs seem to be able to colonize both cattle and humans

Staphylococcus aureus nasal colonization among dental health care workers in Northern Germany (StaphDent study)

Methicillin-resistant Staphylococcus aureus (MRSA) can colonize dental patients and students, however, studies on the prevalence of MRSA and methicillin-susceptible S. aureus (MSSA) among dental health care workers (DHCW) including use of personal protective equipment (PPE) are scarce. We conducted an observational study (StaphDent study) to (I) determine the prevalence of MRSA and MSSA colonization in DHCW in the region of Mecklenburg Western-Pomerania, Germany, (II) resolve the MSSA population structure to gain hints on possible transmission events between co-workers, and (III) clarify use of PPE. Nasal swabs were obtained from dentists (n?=?149), dental assistants (n?=?297) and other dental practice staff (n?=?38). Clonal relatedness of MSSA isolates was investigated using spa typing and, in some cases, whole genome sequencing (WGS). PPE use was assessed by questionnaire. While 22.3% (108/485) of the participants were colonized with MSSA, MRSA was not detected. MSSA prevalence was not associated with size of dental practices, gender, age, or duration of employment. The identified 61 spa types grouped into 17 clonal complexes and four sequence types. Most spa types (n?=?51) were identified only once. In ten dental practices one spa type occurred twice. WGS data analysis confirmed a close clonal relationship for 4/10 isolate pairs. PPE was regularly used by most dentists and assistants. To conclude, the failure to recover MRSA from DHCW reflects the low MRSA prevalence in this region. Widespread PPE use suggests adherence to routine hygiene protocols. Compared to other regional HCW MRSA rates the consequent usage of PPE seems to be protective

Glacial meltwater effects on the carbon cycle of Scoresby Sund (Greenland), the world's largest fjord system

Climate change induced mass loss of the Greenland Ice Sheet increases the amount of meltwater, which is mainly released into the numerous fjords along the coast of Greenland. Due to its low salinity and high silt load, meltwater can profoundly affect the biogeochemical cycling of carbon. We visited the world’s largest fjord system, Scoresby Sund at the eastern coast of Greenland, and its northernmost branch, Nordvestfjord, in the summer of 2016 for investigating biogeochemical carbon cycling. The data reveal that meltwater limited the productivity by inhibiting the resupply of nutrients to the surface and by shadowing the upper part of the water column by the introduction of silts. These silts, though, increased the export of organic carbon to depth by ballasting the sinking organic particles. While the region close to the fjord entrance was influenced by shelf waters, the water column within Nordvestfjord was significantly modulated by meltwater input from a number of marine- and land-terminating glaciers. Our results show that there was a clear gradient from a productive system with efficient remineralization at the mouth of the fjord to a less productive system with a high carbon export towards the inner fjord parts. These results imply that Scoresby Sund can be seen as a hotspot of carbon burial