Fuchs (United Kingdom)

Patterson, Emmy Masur MD; Lim, Jacqueline DO; Fuchs, Paul MD, MPH; Smith, Joshua R. MD; Moussa-Tooks, Alexandra PhD; Ward, Heather Burrell MDEditor(s): Brady, Roscoe MD, PhD, Editor Author Information

Background: Regarding the use of TH for post-cardiac arrest patients, preliminary evidence suggests that more rapid attainment of target temperature (32-34 o C) may improve outcomes. We hypothesized that the time to achieve target temperature is increased as Body Mass Index (BMI) increases and that this may impact clinical outcomes. Objective: To assess for an association of BMI with time to target temperature, skin complications, survival to hospital discharge, and good neurologic outcome (GCS 14-15) in survivors. Methods: Single-center retrospective cohort of cardiac arrest patients who underwent TH using an external cooling system between 7/2007 - 6/2012. We examined the association between BMI (weight in kilograms divided by height in meters squared) and time from initiation of cooling to attainment of target temperature. The cohort was categorized into two groups based on their BMI, (see table 1). The Wilcoxon rank-sum was used to compare time to target temperature by BMI status, categorized as obese and non-obese and the chi-squared was used to compare categorical variables. Results: Of the 179 patients treated with TH, 135 were evaluable. The median age of the cohort was 60 yrs, (IQR 46, 69); 64/135 (47%) were female and 37/135 (27%) had VF/VT as the initial rhythm. Mean time to target temperature was 216 min (IQR 135, 359). Obese compared to non-obese patients required a longer time to achieve target temperature (p=0.07) and obese patients were significantly more likely to have skin breakdown (p=0.01). There was no survival difference between obese and non-obese patients in terms of discharge (53% vs. 45%, p=0.39), nor good neurologic outcome (76% vs. 62%, p=0.26). Conclusions: Obese patients were significantly more likely to experience skin breakdown as a result of TH. There was a suggestion that time to target temperature was prolonged in obese patients. Whether outcomes could have been improved in obese patients if time to target temperature was reduced, is unknown.

Deep vein thrombosis (DVT) is a major health problem that requires improved prophylaxis and treatment. Inflammatory conditions such as infection, cancer, and autoimmune diseases are risk factors for DVT. We and others have recently shown that extracellular DNA fibers produced in inflammation and known as neutrophil extracellular traps (NETs) contribute to experimental DVT. NETs stimulate thrombus formation and coagulation and are abundant in thrombi in animal models of DVT. It appears that, in addition to fibrin and von Willebrand factor, NETs represent a third thrombus scaffold. Here, we review how NETs stimulate thrombosis and discuss known and potential interactions of NETs with endothelium, platelets, red blood cells, and coagulation factors and how NETs could influence thrombolysis. We propose that drugs that inhibit NET formation or facilitate NET degradation may prevent or treat DVT.

The paper presents an analytical investigation of a tapered core optical flber of which the outermost section is loaded with radially anisotropic liquid crystal. The analyses are dealt with transverse modes supported in the flber structure followed by the relative distribution of power in the difierent flber sections. Preliminary dispersion characteristics of the guide are also illustrated. The results demonstrate that the TE modes transport very large amount of power in the outermost liquid crystal region | the criteria much useful for flber optic sensing and fleld coupling devices.

Unter kardiologlscher Basisdiagnostik wird die nichtinvasive Ableitung von kardialen elektrischen Aktionspotentialen in Ruhe und unter Belastung zur Beurteilung der Herzfunktion verstanden. Die technische Weiterentwicklung der EKG-Systeme erzielt eine immer hohere Genauigkeit der diagnostischen (Basis-)Bewertungen des Herzkreislaufsystems und damit eine enorme Verbesserung deren Aussagekraft. Im Folgenden werden die apparativen Verfahren vorgestellt.

Die Uberarbeitung der Automatisierungspyramide als dem zentralen Strukturierungsschema der Automatisierungstechnik ist seit langerer Zeit unabdingbar. Die Technologieentwicklung der letzten 20 Jahre ebenso wie die Veranderung hinsichtlich des Lebenszyklusses von Produktionsanlagen inklusive ihres Engineering und der verstarkte Zwang zur Effizienssteigerung durch Wiederverwendung und Modularisierung werden im Beitrag diskutiert und eine erste Idee einer neuen Architektur entwickelt, welche als Ausgangspunkt fur zukunftige Standardisierungsbemuhungen dienen kann.

DIN EN 61508 und DIN EN 61511 sind mittlerweile akzeptiertes Handwerkszeug fur den Umgang mit Sicherheitskreisen. Im deutschen Sprachraum werden sie durch die abgeleitete VDI/VDE 2180 konkretisiert. Grundlegende Begriffe wie SIL, Ausfallrate, Anteil gefahrlicher Fehler und andere sind im Bewusstsein verankert. Unsicherheiten bestehen dagegen haufig uber eine Vorgehensweise zur praktischen Umsetzung im betrieblichen Alltag. Es gilt, das erforderliche Mas an Betriebssicherheit der Anlage mit gerichtsfesten Nachweismoglichkeiten und praktikablen Losungswegen zu verbinden, die dabei auch okonomische Aspekte einbeziehen. Im Nachfolgenden wird vorausgesetzt, dass aufbauend auf einer Gefahrdungs- und Risikoanalyse die Anforderungen an eine PLT-Schutzeinrichtung (SIF, Safety Instrumented Function) definiert sind. Im Rahmen dieses Artikels wird dargestellt, was bei der Implementierung dieser Schutzeinrichtung zu beachten ist. Es werden Hinweise zum praktischen Einsatz der einzelnen Gerate gegeben. Hierbei werden nicht nur technische Aspekte berucksichtigt, sondern es wird auch die Einbindung in ein ubergeordnetes Sicherheitsmanagement diskutiert.

Abstract Organo‐Lanthanide and Organo‐Main Group Metal Compounds in an Unusual Supramolecular Composition: {[Ln(2,4‐Me2C5H5)3]2·[NaAlEt4]4}(Ln = Nd, La)The pure organometallic supramolecular complexes {[Ln(2,4‐Me2C5H5)3]·[NaAlEt4]4} (Ln = Nd, 1; Ln = La, 2) were obtained by reaction of the known compounds Ln2(η5‐2,4‐Me2C5H5)4Br2 (Ln = Nd, La) with two equivalents of NaAlEt4 in toluene as well crystallized substances. The supramolecular structure of both complexes could be elucidated by X‐ray crystal structure analysis and is described in some details with special consideration of the intermolecular bonding interaction between the different organometallic components. The formation of the Ln(η5‐2,4‐Me2C5H5)3 component is explained by an anion exchange initiated by NaAlEt4.

There is some confusion about the contribution of reversal of residual paralysis to the occurrence of postoperative nausea and vomiting. The aim of this review is to discuss whether antagonism of residual paralysis is a cause of postoperative nausea and vomiting, and to assess the risk of residual paralysis if the reversal is omitted. Data from a meta-analysis published before 1998 were considered, along with trials published after that date to assess the influence of reversal of residual paralysis on postoperative nausea and vomiting, and the likelihood of harm when antagonism was omitted. Moreover, an overview of pathophysiological consequences, incidence and clinical consequences of residual paralysis is given and the actual criteria of the adequacy of neuromuscular recovery presented. When emetic outcomes are combined across all trials and all different neostigmine doses, there is no beneficial effect from omitting neostigmine on postoperative nausea and vomiting, but there is some evidence of a dose-responsiveness with neostigmine; higher doses may have emetic properties. However, omitting reversal introduces a non-negligent risk of residual paralysis. An improved understanding of the pathological consequences of residual paralysis (i.e. impaired laryngeal and pharyngeal muscle function, alterations in hypoxic ventilatory control, reduced margin of safety) led to establishment of more rigorous criteria for defining adequacy of neuromuscular recovery. A train-of-four ratio of > or = 0.9 is now accepted as the index of adequate recovery of neuromuscular function. Applying this new definition, residual paralysis becomes a frequent adverse side-effect. Neuromuscular recovery should therefore be routinely monitored in ambulatory patients and residual paralysis prevented by reversing neuromuscular block.