Outcome after rewarming from accidental hypothermia by use of extracorporeal circulation

Background: Accidental hypothermia with arrested circulation remains a condition associated with high mortality. In our institution, extracorporeal circulation (ECC) rewarming has been the cornerstone in treating such patients since 1987. We here explore characteristics and outcomes of this treatment, to identify significant merits and challenges from 3 decades of experience in ECC rewarming. Methods: Sixty-nine patients rewarmed by ECC during the period from December 1987 to December 2015 were analyzed. One patient was excluded from the analyses because of combined traumatic cerebral injury. The analysis was focused on patient characteristics, treatment procedures, and outcomes were focused. Survivors were evaluated according to the cerebral performance categories scale. Simple statistics with nonparametric tests and χ2 tests were used. Median value and range are reported. Results: Median age was 30 years (minimum 1.5, maximum 76), and the cause of accidental hypothermia was cold exposure (27.9%), avalanche (5.9%), and immersion/submersion accidents (66.2%). Eighteen patients survived (26.5%). The survival rate did not improve during the years. Survivors had lower serum potassium (p = 0.002), higher pH (p = 0.03), lower core temperature (p = 0.02), and shorter cardiopulmonary resuscitation time (p = 0.001), but ranges were wide. Although suspected primary hypoxia and hypothermia were associated with lower survival, we observed a 10.5% survival of these victims. Sixteen survivors had good outcome (cerebral performance category 1 or 2), whereas 2 patients with suspected primary hypoxia survived with severe cerebral disability (cerebral performance category 3). Conclusions: Despite extended experience with ECC rewarming, improved handling strategies, and intensive care, no overall improvement in survival was observed. Good outcome was observed even among patients with a dismal prognosis.publishedVersio

Accelerometry May be Superior to EMG for Early Evaluation of Vocal Cord Function After Nerve Injury in a Pig Model

Objective Vocal cord (VC) movement has been demonstrated by the use of accelerometry (ACC) to decrease in parallel with the electromyographic amplitude (EMG) during ongoing traction injury to the recurrent laryngeal nerve (RLN). When RLN function recovers, discrepancies between EMG and VC movement have been reported in clinical and experimental studies. The present study was conducted to clarify the actual relationship between EMG and VC movement measured by ACC during nerve recovery. Methods EMG obtained by continuous nerve monitoring (C-IONM) was compared with ACC during traction injury to the RLN, and throughout 40-min nerve recovery. A three-axis linear accelerometer probe was attached to the VC, and ACC data were registered as described. Traction damage was applied to the RLN until there was a 70% amplitude decrease from baseline EMG, or until loss of signal (LOS), that is, EMG values ≤100 μV. Results Thirty-two RLN from 16 immature pigs were studied. Correlation between EMG and ACC were calculated during nerve injury and nerve recovery. The mean correlations were for the 70% and LOS group from start to end of traction: 0.82 (±0.17) and 0.87 (±0.17), respectively. Corresponding correlation coefficients during 40-min recovery was 0.50 (±0.48) in the 70% group and 0.53 (±0.33) in the LOS group. Conclusion There is a high correlation between EMG and VC movement during nerve injury, and a moderate correlation during early nerve recovery. EMG recovery after RLN injury ensures sufficient VC function as assessed by ACC.publishedVersio

Kameraovervåkning av hønsefuglreir: hovedresultater fra studieområdet i Trøndelag (studieperioden 2010 – 2013)

I løpet av de fire studieperiodene somrene 2010 - 2013 ble det i studieområdet i Trøndelag totalt meldt inn 142 hønsefuglreir (54 i 2010, 50 i 2011, 38 i 2012 og 29 i 2013). Av disse var h.h.v. 103 storfuglreir, 33 orrfuglreir, 3 jerpereir og 32 lirypereir (figur 1). Av disse 180 reirene var det til sammen 133 reir som ble overvåket enten ved at de hadde kamera montert (129 stk.) eller ved at de ble fulgt opp uten kamera (4 stk.) (figur 2). Artsfordelingen for disse totalt 133 overvåkede reirene i Trøndelag var: 80 røyreir, 25 orrhønereir, 2 jerpereir og 26 lirypereir.Høgskolen i Nord- Trøndelag, Det Kongelige Norske Videnskapers Selskap, Direktoratet for naturforvaltning, Fylkeskommunene i Nord- og Sør-Trøndelag, Midtre-Namdal samkommuneforvaltning, Stjørdal og Lierne kommune

Evaluation of harvesting with excavator assisted ground based system with focus on strip road density

Et meget stort og stadig økende volum hogstmoden skog står i terreng som er så bratt at det ikke kan avvirkes på tradisjonelt vis med hjulgående maskiner. Tidligere var taubane den vanligste metoden brukt i slikt terreng, men den siste tiden har det blitt avvirket mer og mer med såkalte gravedrifter. Hvor det blir gravd midlertidige driftsveier med gravemaskin som hogstmaskin og lassbærer kjører på. Den skogen som eventuelt er utenfor rekkevidden til hogstmaskinen blir felt motormanuelt. Formålet med denne undersøkelsen var å finne de ulike kostnadene for de ulike deloperasjonene ved en gravedrift. For deretter å simulere andre løsninger da først og fremst med lavere tetthet av driftsveier for å se hvordan driftskostnaden ble påvirket av dette. Et annet aspekt av studiet var å se på ulike terrenganalyser for å se om de kan brukes i planleggingsfasen av en gravedrift, og i så fall hvordan de kan brukes. Under de graveforholdene og skogforholdene som var på den studerte drifta, var den laveste beregnede driftskostnaden ved 20 meters avstand mellom driftsveiene og da på 164 kroner pr. m3. Driftskostnaden økte med økende avstand mellom driftsveiene og var høyest ved 60 meters avstand mellom driftsveiene, som her var satt som maksimal avstand. Driftskostnaden ble da 177 kroner pr. m3. Det ble og simulert driftskostnad ved ulike forutsetninger av terrengforhold og skogtetthet. Driftskostnaden varierte da mye, fra 126 kroner pr. m3 under svært gunstige forhold til 228 kroner pr. m3 under svært dårlige forhold. Den optimale veiavstanden ble lengre desto dårligere forholdene var. Terrenganalysene så ut til å stemme godt overens med hva som ble observert i felt. Men med varierende detaljnivå. For å få et godt utbytte av analysene er man avhengig av god vurderingsevne og kjennskap til grunnforhold og klimatiske forhold på det aktuelle stedet.M-S

Outcome after rewarming from accidental hypothermia by use of extracorporeal circulation

Background: Accidental hypothermia with arrested circulation remains a condition associated with high mortality. In our institution, extracorporeal circulation (ECC) rewarming has been the cornerstone in treating such patients since 1987. We here explore characteristics and outcomes of this treatment, to identify significant merits and challenges from 3 decades of experience in ECC rewarming. Methods: Sixty-nine patients rewarmed by ECC during the period from December 1987 to December 2015 were analyzed. One patient was excluded from the analyses because of combined traumatic cerebral injury. The analysis was focused on patient characteristics, treatment procedures, and outcomes were focused. Survivors were evaluated according to the cerebral performance categories scale. Simple statistics with nonparametric tests and χ2 tests were used. Median value and range are reported. Results: Median age was 30 years (minimum 1.5, maximum 76), and the cause of accidental hypothermia was cold exposure (27.9%), avalanche (5.9%), and immersion/submersion accidents (66.2%). Eighteen patients survived (26.5%). The survival rate did not improve during the years. Survivors had lower serum potassium (p = 0.002), higher pH (p = 0.03), lower core temperature (p = 0.02), and shorter cardiopulmonary resuscitation time (p = 0.001), but ranges were wide. Although suspected primary hypoxia and hypothermia were associated with lower survival, we observed a 10.5% survival of these victims. Sixteen survivors had good outcome (cerebral performance category 1 or 2), whereas 2 patients with suspected primary hypoxia survived with severe cerebral disability (cerebral performance category 3). Conclusions: Despite extended experience with ECC rewarming, improved handling strategies, and intensive care, no overall improvement in survival was observed. Good outcome was observed even among patients with a dismal prognosis

0729. Interstitial changes in spleen during sepsis

publishedVersio

Vocal Cord Function During Recurrent Laryngeal Nerve Injury Assessed by Accelerometry and EMG

Objective Gradual impairment of nerve conduction is expected to be tightly associated with simultaneous gradual loss of vocal cord contractility, related to the fact that injured axons are connected to a defined number of muscle cells. In clinical studies, there is a time gap between observed adverse electromyographic (EMG) changes and examination of vocal cord function. This study evaluates the impact of intraoperative EMG changes on synchronous vocal cord contractility by simultaneous use of continuous intraoperative neuromonitoring (C‐IONM) and accelerometry for registration of actual vocal cord function at a given change of EMG amplitude. Methods EMG was obtained following vagus nerve stimulation by use of C‐IONM. A vocal cord accelerometer probe that could be attached to the vocal cords was developed based on a LIS3DH ultra low‐power high performance three axis linear accelerometer (STMicroelectronics, Geneva, Switzerland). Accelerometer data were registered continuously together with EMG data during traction injury of the recurrent laryngeal nerve (RLN) until an amplitude depression ≤100 μV. Results Six RLN from four immature domestic pigs were studied. Vocal cord contractility assessed by vocal cord accelerometry decreased in parallel with EMG amplitude, with significant correlations ranging from 0.707 to 0.968. Conclusion Decrease of EMG amplitude during traction injury to the RLN injury is closely associated with a parallel drop in vocal cord contractility

White matter alterations and their associations with motor function in young adults born preterm with very low birth weight.

Very low birth weight (VLBW: ≤ 1500 g) individuals have an increased risk of white matter alterations and neurodevelopmental problems, including fine and gross motor problems. In this hospital-based follow-up study, the main aim was to examine white matter microstructure and its relationship to fine and gross motor function in 31 VLBW young adults without cerebral palsy compared with 31 term-born controls, at mean age 22.6 ± 0.7 years. The participants were examined with tests of fine and gross motor function (Trail Making Test-5: TMT-5, Grooved Pegboard, Triangle from Movement Assessment Battery for Children-2: MABC-2 and High-level Mobility Assessment Tool: HiMAT) and diffusion tensor imaging (DTI). Probabilistic tractography of motor pathways of the corticospinal tract (CST) and corpus callosum (CC) was performed. Fractional anisotropy (FA) was calculated in non-crossing (capsula interna in CST, body of CC) and crossing (centrum semiovale) fibre regions along the tracts and examined for group differences. Associations between motor test scores and FA in the CST and CC were investigated with linear regression. Tract-based spatial statistics (TBSS) was used to examine group differences in DTI metrics in all major white matter tracts. The VLBW group had lower scores on all motor tests compared with controls, however, only statistically significant for TMT-5. Based on tractography, FA in the VLBW group was lower in non-crossing fibre regions and higher in crossing fibre regions of the CST compared with controls. Within the VLBW group, poorer fine motor function was associated with higher FA in crossing fibre regions of the CST, and poorer bimanual coordination was additionally associated with lower FA in crossing fibre regions of the CC. Poorer gross motor function was associated with lower FA in crossing fibre regions of the CST and CC. There were no associations between motor function and FA in non-crossing fibre regions of the CST and CC within the VLBW group. In the TBSS analysis, the VLBW group had lower FA and higher mean diffusivity compared with controls in all major white matter tracts. The findings in this study may indicate that the associations between motor function and FA are caused by other tracts crossing the CST and CC, and/or by alterations in the periventricular white matter in the centrum semiovale. Some of the associations were in the opposite direction than hypothesized, thus higher FA does not always indicate better function. Furthermore, widespread white matter alterations in VLBW individuals persist into young adulthood