Transdiaphragmatic Resuscitative Open Cardiac Massage: Description of the Technique and a First Case-Series of an Alternative Approach to the Heart

Abstract BACKGROUND: The purpose of this paper is to describe the transdiaphragmatic approach to the heart for open CPR in patients that arrest at laparotomy and to present a first case series of patients that have undergone this procedure. METHODS: All patients who had undergone intraperitoneal transdiaphragmatic open CPR between January 1, 2002 and December 31, 2012 were retrieved from the operation registry at Bern University Hospital, Switzerland. Transdiaphragmatic access to the heart is initiated with a 10-cm-long anterocaudal incision in the central tendon of the diaphragm--approximately at 2 o'clock. Internal cardiac compression through the diaphragmatic incision can be performed from both sides of the patient. From the right side of the patient, cardiac massage is performed with the right hand and vice versa. RESULTS: A total of six patients were identified that suffered cardiac arrest during laparotomy with open CPR performed through the transdiaphragmatic approach. Four patients suffered cardiac arrest during orthotopic liver transplantation and two trauma patients suffered cardiac arrest during damage control laparotomy. In three patients, cardiac activity was never reestablished. However, three patients regained a perfusion heart rhythm and two of these survived to the ICU. One patient ultimately survived to discharge. CONCLUSIONS: In patients suffering cardiac arrest during laparotomy, the transdiaphragmatic approach allows for a rapid, technically easy, and almost atraumatic access to the heart, with excellent CPR performance. After this potentially life-saving procedure, pulmonary or surgical site complications are expected to occur much less compared with the conventionally performed emergency department left-sided thoracotomy.

Molecular Analyses Define Vα7.2-Jα33+ MAIT Cell Depletion in HIV Infection: A Case-Control Study

Mucosal-associated invariant T (MAIT) cells are an abundant antibacterial innate-like lymphocyte population. There are conflicting reports as to their fate in HIV infection. The objective of this study was to determine whether MAIT cells are truly depleted in HIV infection.In this case-control study of HIV-positive patients and healthy controls, quantitative real-time polymerase chain reaction was used to assess the abundance of messenger RNA (mRNA) and genomic DNA (gDNA) encoding the canonical MAIT cell T cell receptor (Vα7.2-Jα33). Comparison was made with flow cytometry.Significant depletion of both Vα7.2-Jα33 mRNA and gDNA was seen in HIV infection. Depletion of Vα7.2+CD161++ T cells was confirmed by flow cytometry. In HIV infection, the abundance of Vα7.2-Jα33 mRNA correlated most strongly with the frequency of Vα7.2+CD161++ cells. No increase was observed in the frequency of Vα7.2+CD161- cells among CD3+CD4- lymphocytes.MAIT cells are depleted from blood in HIV infection as confirmed by independent assays. Significant accumulation of a CD161- MAIT cell population is unlikely. Molecular approaches represent a suitable alternative to flow cytometry-based assays for tracking of MAIT cells in HIV and other settings.

Choking under Pressure und Ego Depletion: Eine Erweiterung der Attentional Control Theory und mögliche Interventionsmaßnahmen

In Leistungssituationen sind Athletinnen und Athleten nicht immer dazu in der Lage, ihr Leistungsoptimum abzurufen. Auch wenn die Befundlage zum Angst-Leistungszusammenhang äußerst heterogen ist, so geht höheres Angsterleben häufig mit Leistungsbeeinträchtigungen einher. In dem vorliegenden Manuskript wird ein Überblick über verschiedene theoretische Modelle zur Erklärung des Angst-Leistungszusammenhangs gegeben. Der Fokus wird dabei auf die Attentional Control Theory gelegt, die besagt, dass unter Druck die Aufmerksamkeitsregulation weniger effizient ausfällt und folglich erhöhte Ablenkbarkeit die Leistung negativ beeinflusst. Es wird weiterhin argumentiert, dass die Selbstkontrollkraft den Angst-Leistungszusammenhang moderiert, so dass nur bei Personen mit temporär erschöpfter Selbstkontrollkraft ein negativer Angst-Leistungszusammenhang erwartet wird, wohingegen Personen mit momentan verfügbarer Selbstkontrollkraft trotz erhöhten Angsterlebens Höchstleistung erbringen können. Abschließend werden offene Fragestellungen thematisiert, alternative Erklärungsansätze vorgestellt sowie praktische Implikationen für die Sportpsychologie abgeleitet.

Reconciling two alternative mechanisms behind bi-decadal variability in the North Atlantic

Understanding the preferential timescales of variability in the North Atlantic, usually associated with the Atlantic meridional overturning circulation (AMOC), is essential for the prospects for decadal prediction. However, the wide variety of mechanisms proposed from the analysis of climate simulations, potentially dependent on the models themselves, has stimulated the debate of which processes take place in reality. One mechanism receiving increasing attention, identified both in idealized models and observations, is a westward propagation of subsurface buoyancy anomalies that impact the AMOC through a basin-scale intensification of the zonal density gradient, enhancing the northward transport via thermal wind balance. In this study, we revisit a control simulation from the Institut Pierre-Simon Laplace Coupled Model 5A (IPSL-CM5A), characterized by a strong AMOC periodicity at 20 years, previously explained by an upper ocean–atmosphere–sea ice coupled mode driving convection activity south of Iceland. Our study shows that this mechanism interacts constructively with the basin-wide propagation in the subsurface. This constructive feedback may explain why bi-decadal variability is so intense in this coupled model as compared to others.

Comparison of proximal femur and vertebral body strength improvements in the FREEDOM trial using an alternative finite element methodology

Denosumab reduced the incidence of new fractures in postmenopausal women with osteoporosis by 68% at the spine and 40% at the hip over 36 months compared with placebo in the FREEDOM study. This efficacy was supported by improvements from baseline in vertebral (18.2%) strength in axial compression and femoral (8.6%) strength in sideways fall configuration at 36 months, estimated in Newtons by an established voxel-based finite element (FE) methodology. Since FE analyses rely on the choice of meshes, material properties, and boundary conditions, the aim of this study was to independently confirm and compare the effects of denosumab on vertebral and femoral strength during the FREEDOM trial using an alternative smooth FE methodology. Unlike the previous FE study, effects on femoral strength in physiological stance configuration were also examined. QCT data for the proximal femur and two lumbar vertebrae were analyzed by smooth FE methodology at baseline, 12, 24, and 36 months for 51 treated (denosumab) and 47 control (placebo) subjects. QCT images were segmented and converted into smooth FE models to compute bone strength. L1 and L2 vertebral bodies were virtually loaded in axial compression and the proximal femora in both fall and stance configurations. Denosumab increased vertebral body strength by 10.8%, 14.0%, and 17.4% from baseline at 12, 24, and 36 months, respectively (p < 0.0001). Denosumab also increased femoral strength in the fall configuration by 4.3%, 5.1%, and 7.2% from baseline at 12, 24, and 36 months, respectively (p < 0.0001). Similar improvements were observed in the stance configuration with increases of 4.2%, 5.2%, and 5.2% from baseline (p ≤ 0.0007). Differences between the increasing strengths with denosumab and the decreasing strengths with placebo were significant starting at 12 months (vertebral and femoral fall) or 24 months (femoral stance). Using an alternative smooth FE methodology, we confirmed the significant improvements in vertebral body and proximal femur strength previously observed with denosumab. Estimated increases in strength with denosumab and decreases with placebo were highly consistent between both FE techniques.

Periacetabular osteotomy through the pararectus approach: technical feasibility and control of fragment mobility by a validated surgical navigation system in a cadaver experiment

PURPOSE The pararectus approach has been validated for managing acetabular fractures. We hypothesised it might be an alternative approach for performing periacetabular osteotomy (PAO). METHODS Using four cadaver specimens, we randomly performed PAO through either the pararectus or a modified Smith-Petersen (SP) approach. We assessed technical feasibility and safety. Furthermore, we controlled fragment mobility using a surgical navigation system and compared mobility between approaches. The navigation system's accuracy was tested by cross-examination with validated preoperative planning software. RESULTS The pararectus approach is technically feasible, allowing for adequate exposure, safe osteotomies and excellent control of structures at risk. Fragment mobility is equal to that achieved through the SP approach. Validation of these measurements yielded a mean difference of less <1 mm without statistical significance. CONCLUSION Experimental data suggests the pararectus approach might be an alternative approach for performing PAO. Clinical validation is necessary to confirm these promising preliminary results.

Alternative nighttime nutrition regimens in glycogen storage disease type I: a controlled crossover study

BACKGROUND Traditional approaches for nighttime glycemic control in glycogen storage disease type I (GSDI) include continuous tube feeding, or ingestion of uncooked corn starch (CS) at bedtime. A modified corn starch (MCS) has been shown to prolong euglycemia in some patients. The aim of this study was to evaluate whether stable nighttime glucose control can be achieved with other types of slowly digested carbohydrates in adult GSDI patients. METHODS In this cross-over study, nocturnal glucose control and fasting times were assessed with three different nocturnal nutrition regimens in five patients, using continuous glucose monitoring (CGMS) in an outpatient everyday life setting. For each patient, continuous glucose profiles were measured after ingestion of (1) CS, (2) MCS or (3) a pasta meal at bedtime, during 5 to 6 consecutive nights for each regimen. RESULTS Stable nocturnal glucose control was achieved for all patients with a pasta meal, with a mean duration of glycemia >3.5 mmol/l of 7.6 h (range 5.7-10.8), and >4 mmol/l of 7 h (5.2-9.2), similar to CS and MCS. Fasting glucose before breakfast on workdays (after 7.1 ± 0.8 h) was not significantly different between the three interventions (CS 4.1 ± 0.5 mmol/l, MCS 4.6 ± 0.7 mmol/l, pasta 4.3 ± 0.9 mmol/l). During prolonged fasting on weekends, longer duration of normoglycemia was achieved with CS or MCS than with pasta. CONCLUSION Consumption of cooked pasta is a suitable and more palatable alternative to uncooked corn starch to achieve nighttime glucose control in adult patients with GSDI.

Emissions Control and the Regulation of Product Markets: The Case of Automobiles

The paper investigates alternative policies to regulate emissions from polluting product markets, specifically considering the case of the automobiles market. The two policies we consider are: a quota that limits the quantity produced of the polluting model and a more flexible average efficiency standard that requires a minimum energy efficiency across all models produced by a firm, similar to the US Corporate Average Fuel Economy (CAFE) standards. We use a duopoly model of vertical differentiation where firms produce both an economy (i.e., low polluting) version and a luxury (i.e., high polluting) version of a given product. We show that while a quota can raise firm profit over a certain range, CAFE always reduces firm profit relative to the pre-regulation. We also show that while the quota reduces emissions, it is possible that emissions increase under CAFE. The optimal policy choice will depend on the magnitude of unit damages. We show that when unit damages are sufficiently high, the quota policy is more efficient than the average efficiency standard. This suggests that instead of tightening CAFE to limit damages from emissions, policy makers can shift to a quota policy which is both welfare enhancing and more profitable for firms.

Mechanism of mRNA stability control mediated by AU -rich element: Characterization of cis-elements and trans-factors

Regulation of cytoplasmic deadenylation, the first step in mRNA turnover, has direct impact on the fate of gene expression. AU-rich elements (AREs) found in the 3′ untranslated regions of many labile mRNAs are the most common RNA-destabilizing elements known in mammalian cells. Based on their sequence features and functional properties, AREs can be divided into three classes. Class I or class III ARE directs synchronous deadenylation, whereas class II ARE directs asynchronous deadenylation with the formation of poly(A)-intermediates. Through systematic mutagenesis study, we found that a cluster of five or six copies of AUUUA motifs forming various degrees of reiteration is the key feature dictating the choice between asynchronous versus synchronous deadenylation. A 20–30 nt AU-rich sequence immediately 5 ′ to this cluster of AUUUA motifs can greatly enhance its destabilizing ability and is an integral part of the AREs. These two features are the defining characteristics of class II AREs. ^ To better understand the decay mechanism of AREs, current methods have several limitations. Taking the advantage of tetracycline-regulated promoter, we developed a new transcriptional pulse strategy, Tet-system. By controlling the time and the amount of Tet addition, a pulse of RNA could be generated. Using this new system, we showed that AREs function in both growth- and density-arrested cells. The new strategy offers for the first time an opportunity to investigate control of mRNA deadenylation and decay kinetics in mammalian cells that exhibit physiologically relevant conditions. ^ As a member of heterogeneous nuclear RNA-binding protein, hnRNP D 0/AUF1 displays specific affinities for ARE sequences in vitro . But its in vivo function in ARE-mediated mRNA decay is unclear. AUF1/hnRNP D0 is composed of at least four isoforms derived by alternative RNA splicing. Each isoform exhibits different affinity for ARE sequence in vitro. Here, we examined in vivo effect of AUF1s/hnRNP D0s on degradation of ARE-containing mRNA. Our results showed that all four isoforms exhibit various RNA stabilizing effects in NIH3T3 cells, which are positively correlated with their binding affinities for ARE sequences. Further experiments indicated that AUF1/hnRNP D0 has a general role in modulating the stability of cytoplasmic mRNAs in mammalian cells. ^

Actividad biológica de Lonchocarpus guaricensis Pittier en el control de larvas de Tuta absoluta (Meyrick)

La actividad biológica de Lonchocarpus guaricensis Pittier fue evaluada utilizando dos dosis de Tecnona® en el control de larvas de Tuta absoluta (Meyrick), Valle de Azapa, Chile, mediante una pulverización sobre plantas de tomate cv. Naomi en macetas, ubicadas aleatoriamente en un invernáculo dentro de un vivero. Semanas previas a la pulverización, las macetas se infestaron artificialmente con adultos del fitófago para obtener larvas en los foliolos. Los tratamientos evaluados fueron los siguientes: T1 (0,21 g de IA de L. guaricensis·L-1), T2 (0,43 g de IA de L. guaricensis·L-1), T3 (control positivo a base de spinosad 0,048 g de IA·L-1) y T0 (control negativo a base de agua de pozo). De acuerdo con el porcentaje de mortalidad acumulada de larvas contabilizadas a las 24, 48, 120 horas y 9no día post aplicación, no hay diferencias estadísticas entre los tratamientos T0 y T1, a su vez, T2 alcanza una media de 53,05% de mortalidad, no diferenciándose de T3 que logra un 73,9%. Se concluye que la dosis experimental L. guaricensis de 0,43 g de IA∙ L-1 puede constituir una alternativa interesante de utilizar en el Manejo Integrado de Plagas del cultivo de tomate en el Valle de Azapa.

El control social sobre los docentes durante la última dictadura militar. Un análisis de los sumarios administrativos en la provincia de Buenos Aires, 1976-1983

En este artículo analizamos las políticas de control social dirigidas hacia los docentes durante la dictadura militar de 1976-1983 y la agencia de los actores encargados de implementarlas, tomando como objeto de análisis la serie completa de los sumarios administrativos que elaboraron los inspectores en esos años en la provincia de Buenos Aires. Siguiendo un enfoque heterodoxo de la historiografía del control social, pretendemos reconocer las contradicciones existentes en el funcionamiento cotidiano de los "aparatos de control", la agencia de los sujetos localizados en las posiciones intermedias del Estado y las múltiples formas en que ese control se ejercía efectiva y cotidianamente.

El control social sobre los docentes durante la última dictadura militar. Un análisis de los sumarios administrativos en la provincia de Buenos Aires, 1976-1983

En este artículo analizamos las políticas de control social dirigidas hacia los docentes durante la dictadura militar de 1976-1983 y la agencia de los actores encargados de implementarlas, tomando como objeto de análisis la serie completa de los sumarios administrativos que elaboraron los inspectores en esos años en la provincia de Buenos Aires. Siguiendo un enfoque heterodoxo de la historiografía del control social, pretendemos reconocer las contradicciones existentes en el funcionamiento cotidiano de los "aparatos de control", la agencia de los sujetos localizados en las posiciones intermedias del Estado y las múltiples formas en que ese control se ejercía efectiva y cotidianamente.

El control social sobre los docentes durante la última dictadura militar. Un análisis de los sumarios administrativos en la provincia de Buenos Aires, 1976-1983

En este artículo analizamos las políticas de control social dirigidas hacia los docentes durante la dictadura militar de 1976-1983 y la agencia de los actores encargados de implementarlas, tomando como objeto de análisis la serie completa de los sumarios administrativos que elaboraron los inspectores en esos años en la provincia de Buenos Aires. Siguiendo un enfoque heterodoxo de la historiografía del control social, pretendemos reconocer las contradicciones existentes en el funcionamiento cotidiano de los "aparatos de control", la agencia de los sujetos localizados en las posiciones intermedias del Estado y las múltiples formas en que ese control se ejercía efectiva y cotidianamente.

The DLMT. An alternative to the DCT

In the last recent years, with the popularity of image compression techniques, many architectures have been proposed. Those have been generally based on the Forward and Inverse Discrete Cosine Transform (FDCT, IDCT). Alternatively, compression schemes based on discrete “wavelets” transform (DWT), used, both, in JPEG2000 coding standard and in the next H264-SVC (Scalable Video Coding), do not need to divide the image into non-overlapping blocks or macroblocks. This paper discusses the DLMT (Discrete Lopez-Moreno Transform). It proposes a new scheme intermediate between the DCT and the DWT (Discrete Wavelet Transform). The DLMT is computationally very similar to the DCT and uses quasi-sinusoidal functions, so the emergence of artifact blocks and their effects have a relative low importance. The use of quasi-sinusoidal functions has allowed achieving a multiresolution control quite close to that obtained by a DWT, but without increasing the computational complexity of the transformation. The DLMT can also be applied over a whole image, but this does not involve increasing computational complexity. Simulation results in MATLAB show that the proposed DLMT has significant performance benefits and improvements comparing with the DCT

The scaled-time test as an alternative to the pseudo-dynamic test

The stepped and excessively slow execution of pseudo-dynamic tests has been found to be the source of some errors arising from strain-rate effect and stress relaxation. In order to control those errors, a new continuous test method which allows the selection of a more suitable time scale factor in the response is proposed in this work. By dimensional analysis, such scaled-time response is obtained theoretically by augmenting the inertial and damping properties of the structure, for which we propose the use of hydraulic pistons which are servo-controlled to produce active mass and damping, nevertheless using an equipment which is similar to that required in a pseudo-dynamic test. The results of the successful implementation of this technique for a simple specimen are shown here.