Comparison of the C‐MAC® and GlideScope® videolaryngoscopes in patients with cervical spine disorders and immobilisation

In‐line stabilisation of the neck can increase the difficulty of tracheal intubation with direct laryngoscopy. We randomly assigned 56 patients with cervical spine pathology scheduled for elective surgery to tracheal intubation using either the C‐MAC^® (n = 26) or GlideScope^® (n = 30), when the head and neck were stabilised in‐line. There was no significant difference in the median (IQR [range]) intubation times between the C‐MAC (19 (14–35 [9–90]) s and the GlideScope (23, (15–32 [8–65]) s. The first‐attempt failure rate for the C‐MAC was 42% (95% CI 23–63%) compared with 7% (95% CI 1–22%) for the GlideScope, p = 0.002. The laryngeal view was excellent and comparable with both devices, with the C‐MAC requiring significantly more attempts and optimising manoeuvers (11 vs 5, respectively, p = 0.04). There were no significant differences in postoperative complaints e.g. sore throat, hoarseness and dysphagia. Both devices provided an excellent glottic view in patients with cervical spine immobilisation, but tracheal intubation was more often successful on the first attempt with the GlideScope.     

K-ras mutations in the bile of patients with primary sclerosing cholangitis

BACKGROUND AND AIMS: The development of cholangiocarcinoma (CCC) is a complication of primary sclerosing cholangitis (PSC). To date, no reliable factors have been described which can define those PSC patients at high risk for the development of CCC and the clinical diagnosis of CCC in PSC patients is difficult. Therefore, molecular markers of cholangiocarcinogenesis, such as K-ras mutations, may improve the early diagnosis of CCC or the timing of liver transplantation. METHODS: K-ras mutations were analysed by enriched polymerase chain reaction/restriction fragment length polymorphism in the bile fluid of 56 PSC patients and 20 patients with other cholestatic diseases. To assess the value of K-ras mutations as a risk factor for cholangiocarcinogenesis, patients were prospectively investigated over a mean period of 31.5 months. RESULTS: In contrast with the control group, 17 (30%) patients with PSC revealed K-ras mutations in bile fluid. The mean Mayo score was not significantly different between PSC patients with (mean score 0.70) and without (mean score 0.13; p=0.2) K-ras mutations. In contrast with the group of PSC patients without K-ras mutations, four CCCs and two dysplasia were diagnosed in the group of patients with K-ras mutations during the follow up investigation (p<0.001). CONCLUSIONS: Our results indicate that K-ras mutations in bile fluid of PSC patients represent frequent early events during cholangiocarcinogenesis. However, most of the PSC patients with K-ras mutations remained tumour free after a long follow up investigation which is in agreement with the fact that these mutations are not specific for malignancy but may also occur in normal bile duct mucosa or in dysplasias. Therefore, analysis of K-ras mutations in bile should not be used for diagnosis of CCC in PSC patients. However, the results of our prospective follow up investigation indicate that K-ras mutations in bile fluid of PSC patients have to be considered as risk factors for the development of CCC which may have implications for the timing of liver transplantation.     

Single-port laparoscopic cholecystectomy versus standard multiport laparoscopic cholecystectomy: a case–control study comparing the long-term quality of life and body image

Purpose

To study the postoperative quality of life and body image of patients who underwent either single-port cholecystectomy (SPC) or standard multiport laparoscopic cholecystectomy (SMLC) in a long-term assessment.

Methods

Fifty patients who underwent SPC using the reusable X-Cone? Laparoscopic Device were compared with a matched group (age, sex, body mass index) of 50 patients after SMLC. The health-related quality of life (HRQOL) and body image at 17 months postoperatively (median, range 9–23) was analysed by means of the Short-Form 12 Health Survey and the Body Image Questionnaire, respectively.

Results

Both patient groups had comparable baseline characteristics, clinical courses, and postoperative complication rates. SPC patients were significantly more satisfied with the cosmetic result of their scar at 17 months postoperatively, in comparison to SMLC patients (cosmetic scale: 22.6 ± 2.8 vs. 19.5 ± 3.7, p < 0.001). However, the HRQOL did not differ between the SPC and SMLC patients (physical component scale: 50.0 ± 8.9 vs. 48.8 ± 9.4, p = 0.48; mental component scale: 53.8 ± 6.5 vs. 51.3 ± 8.5, p = 0.10).

Conclusion

Although the overall postoperative HRQOL was comparable, this study suggests that the cosmetic result of SPC after complete wound healing is superior to the standard multiport laparoscopic procedure.     

Risk and protective factors for antepartum and postpartum depression: a prospective study

Introduction: Antepartum risk and protective factors for postpartum depression (PPD; the most common mental disorder after childbirth besides postpartum anxiety), have been frequently investigated in cross-sectional studies, but less often longitudinally. This study examined linear and moderator effects of risk and protective factors for peripartum depression. First, we investigated the predictive power of risk factors (physical problems during pregnancy, pregnancy-related anxiety, stressful life events, dysfunctional self-consciousness (DSC)) and protective factors (resilience, social support) for antepartum depression (APD) and PPD. Second, as DSC plays an important role in major depression, we examined whether the protective factors moderate the association between the risk factors DSC and APD as well as PPD.

Methods: We conducted a prospective study with three measurement time points: six weeks antepartum (N?=?297), as well as six weeks (N?=?278) and twelve weeks (N?=?266) postpartum. Direct and moderator effects on APD were analyzed using hierarchical regression analysis. Moderated mediation effects were investigated to explore whether the indirect, long-term effect of DSC on PPD six weeks after birth (PPD-6) and PPD twelve weeks after birth (PPD-12) is moderated by resilience.

Results: Predictors for APD were high DSC, high concerns about one’s appearance, low resilience and low social support. Resilience buffered (weakened) the impact of DSC on APD and affected PPD-6 and PPD-12 indirectly through APD.

Discussion: The results suggest that PPD-12 is influenced directly and indirectly through PPD-6 by APD, but that this effect depends upon risk and protective factors, especially on the combined effects of resilience and DSC. The key finding of our study is the moderating (i.e. weakening) effect of resilience on the relationship between DSC and depression. Resilience and DSC may be an important issue for depression prevention and treatment programs in the peripartum period.     

Rocaglates as Antivirals: Comparing the Effects on Viral Resistance,Anti-Coronaviral Activity,RNA-Clamping on eIF4A and Immune Cell Toxicity

Rocaglates are potent broad-spectrum antiviral compounds with a promising safety profile. They inhibit viral protein synthesis for different RNA viruses by clamping the 5′-UTRs of mRNAs onto the surface of the RNA helicase eIF4A. Apart from the natural rocaglate silvestrol, synthetic rocaglates like zotatifin or CR-1-31-B have been developed. Here, we compared the effects of rocaglates on viral 5′-UTR-mediated reporter gene expression and binding to an eIF4A-polypurine complex. Furthermore, we analyzed the cytotoxicity of rocaglates on several human immune cells and compared their antiviral activities in coronavirus-infected cells. Finally, the potential for developing viral resistance was evaluated by passaging human coronavirus 229E (HCoV-229E) in the presence of increasing concentrations of rocaglates in MRC-5 cells. Importantly, no decrease in rocaglate-sensitivity was observed, suggesting that virus escape mutants are unlikely to emerge if the host factor eIF4A is targeted. In summary, all three rocaglates are promising antivirals with differences in cytotoxicity against human immune cells, RNA-clamping efficiency, and antiviral activity. In detail, zotatifin showed reduced RNA-clamping efficiency and antiviral activity compared to silvestrol and CR-1-31-B, but was less cytotoxic for immune cells. Our results underline the potential of rocaglates as broad-spectrum antivirals with no indications for the emergence of escape mutations in HCoV-229E.     

Oral contrast medium in PET/CT: should you or shouldn’t you?

Purpose It has been suggested that the use of computed tomography (CT) positive contrast agents has led to attenuation-induced artefacts on ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET/CT) systems. Consequently, centres may withhold the use of such agents. Whilst there is theoretical evidence to support the aforementioned claim, the clinical relevance of the induced artefacts has not been widely established. Moreover, the potential benefits of bowel enhancement on PET/CT have yet to be formally evaluated. We therefore prospectively examined PET/CT studies to assess whether the use of oral contrast medium induces clinically relevant artefacts and whether the use of these agents is diagnostically helpful.Methods Over a 2-month period, ¹⁸F-FDG PET/CT images were prospectively reviewed from 200 patients following Gastrografin administration 2 h prior to examination. Both a radiologist and a nuclear medicine physician reviewed the images for contrast medium-mediated clinically relevant artefacts. Artefacts were sought on the CT attenuation-corrected images and were compared with the appearance on non-attenuated-corrected images. The number of examinations in which the oral contrast aided image interpretation was also noted.Results There were no oral contrast medium-induced clinically significant artefacts. In 38 of the 200 patients, oral contrast aided image interpretation (owing to differentiation of mass/node from bowel, discrimination of intestinal wall from lumen or definition of the anatomy of a relevant site). In 33 of these 38 patients, the anatomical site of interest was the abdomen/pelvis.Conclusion The use of oral contrast medium in ¹⁸F-FDG PET studies should not be withheld as it improves image interpretation and does not produce clinically significant artefacts.     

Effects of Cold and Compression on Edema

In brief: A 40-minute cooling period was used to treat artificially induced acute inflammatory reactions in human tissue. Results showed no significant change in the volume of the inflammatory reaction at one hour, though a transient attenuation during the first 15 minutes was detected. The addition of mild pressure (10 mm Hg) to mild cooling (range, 15° to 25° C) produced a highly significant reduction in swelling from 15 minutes onward, This effect was sustained as long as swelling was detectable. Pressure alone (20 mm Hg) had a nonsignificant effect. The authors compare two cooling devices, an inflatable cooling cuff and an evaporative bandage, which were both found to be effective. The authors suggest that these devices could be used more routinely in emergency medicine.