Atemwegsmanagement: alternative Techniken

Adequate oxygenation of the patient is the key principle in most emergencies. Airway management is not the use of specific devices, but a concept that considers all options to deliver oxygen to the patient. Mask ventilation and intubation are subject to restrictions due to the need for training and the specifics of the prehospital setting. The use of supraglottic alternatives to mask ventilation and tracheal intubation such as laryngeal masks, combitube and laryngeal tubes is an important option in contemporary airway management. Availability, training and use of adequate devices must be considered a standard. Emergency cricothyrotomy should only be considered as a last resolve when less invasive strategies fail.     

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Scaffold protein harmonin (USH1C) provides molecular links between Usher syndrome type 1 and type 2

Usher syndrome (USH) is the most frequent cause of combined deaf-blindness in man. USH is clinically and genetically heterogeneous with at least 11 chromosomal loci assigned to the three USH types (USH1A-G, USH2A-C, USH3A). Although the different USH types exhibit almost the same phenotype in human, the identified USH genes encode for proteins which belong to very different protein classes and families. We and others recently reported that the scaffold protein harmonin (USH1C-gene product) integrates all identified USH1 molecules in a USH1-protein network. Here, we investigated the relationship between the USH2 molecules and this USH1-protein network. We show a molecular interaction between the scaffold protein harmonin (USH1C) and the USH2A protein, VLGR1 (USH2C) and the candidate for USH2B, NBC3. We pinpoint these interactions to interactions between the PDZ1 domain of harmonin and the PDZ-binding motifs at the C-termini of the USH2 proteins and NBC3. We demonstrate that USH2A, VLGR1 and NBC3 are co-expressed with the USH1-protein harmonin in the synaptic terminals of both retinal photoreceptors and inner ear hair cells. In hair cells, these USH proteins are also localized in the signal uptaking stereocilia. Our data indicate that the USH2 proteins and NBC3 are further partners in the supramolecular USH-protein network in the retina and inner ear which shed new light on the function of USH2 proteins and the entire USH-protein network. These findings provide first evidence for a molecular linkage between the pathophysiology in USH1 and USH2. The organization of USH molecules in a mutual 'interactome' related to the disease can explain the common phenotype in USH.     

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Reflex responses induced by tooth unloading

The reflex response of the masseter muscle to the rapid unloading of a single maxillary incisor tooth was studied. Unloading of a static force of 2 N in the horizontal direction resulted in a short-latency excitation, inhibition, and long-latency excitation of masseter muscle activity occurring at latencies of approximately 13, 20, and 40 ms, respectively, with a corresponding change in bite force occurring slightly later in each case. Following the blocking of periodontal input by the injection of local anesthetic around the stimulated tooth, inhibitory responses were abolished. Therefore, it is concluded that the observed masseteric inhibition was caused by the unloading of periodontal mechanoreceptors and thus that these receptors may contribute to the jaw unloading reflex.     

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Effects of common excitatory and inhibitory inputs on motoneuron synchronization.

We compared the effects of common excitatory and inhibitory inputs on motoneuron synchronization by simulating synaptic inputs with injected current transients. We elicited repetitive discharge in hypoglossal motoneurons recorded in slices of rat brain stem using a combination of a suprathreshold injected current step with superimposed noise to mimic the synaptic drive likely to occur during physiological activation. The effects of common inputs to motoneurons were simulated by the addition of a waveform composed of from 6 to 300 trains of current transients designed to mimic excitatory and/or inhibitory synaptic currents. We compared the discharge records obtained in several trials in which the same "common input" waveform was applied repeatedly in the presence of different background noise waveforms. The effects of the common input on motoneuron discharge probability and discharge rate were determined by compiling a cross-correlation histogram (CCHist) and a perispike frequencygram (PSFreq) between the discharges of the same cell at different times. Both excitatory and inhibitory common inputs induced synchronous discharge that was evident by a large central peak in the CCHist. The CCHists produced by common excitatory inputs were characterized by larger and narrower central peaks than those generated by common inhibitory inputs. The PSFreqs produced by common excitatory inputs indicated an increase in the discharge rate of motoneurons around time 0 that coincided with the narrow and large central peak in the CCHist. On the other hand, inhibitory inputs often generated very little, if any, change in the discharge rate around time 0 corresponding with the small and wide central peak in the CCHist. These results suggest that the CCHist indicates the effective strength of the net common input but not its sign. Although correlated changes in discharge rate are often quite different for net excitatory and inhibitory common input, except in some restricted conditions, the PSFreq analysis also cannot be used to unambiguously distinguish net excitation from net inhibition.     

Cholesterol feeding attenuates endothelium-dependent relaxation response to acetylcholine in the main pulmonary artery of chickens

The endothelium-dependent relaxation in response to acetylcholine was significantly less in pulmonary artery strips from chickens fed 5% cholesterol for 4 weeks than in strips from animals fed an 'ordinary' diet. No relaxation was observed in the strips from either group when the endothelium was disrupted or the strips were pretreated with hydroquinone. These results indicate that the relaxing effect of acetylcholine is endothelium-dependent and that hypercholesterolemia leads to an impairment of the endothelium-mediated relaxation response of the pulmonary artery strips to acetylcholine.     

A comparison of double single suture-button fixation,suture-button fixation,and screw fixation for ankle syndesmosis injury: A retrospective cohort study

Different methods have been used throughout the years for syndesmotic injury but there is no consensus on the ideal treatment. Some methods are expensive and some have more complications. The aim of this study is to compare single suture endobutton with double suture endobutton and screw fixation for syndesmotic injury.Sixty nine patients with syndesmotic injury with fibular fractures whom were treated with a single interosseous suture endobutton system (ZipTight^TM, Zimmer Biomet), a double interosseous suture endobutton system (ZipTight^TM, Zimmer Biomet) and 1 syndesmotic screw (TST, Istanbul, Turkey) were included in this study. Functional and radiological results from patient records between 2015 and 2018 were retrospectively evaluated.Twenty patients were treated with the double interosseous suture endobutton, 23 were treated with the single interosseous suture endobutton, and 26 were treated with traditional AO screw fixation. Three patients from the screw fixation group (11.5%) required revision surgery (P < .05). All the radiologic and clinical outcomes were statistical similar in all 3 groups.Our findings showed that the interosseous suture endobutton system is at least as safe as the screw fixation technique for treatment of syndesmosis joint injuries and can be used as an alternative to the screw method. The interosseous suture endobutton system eliminates the need for a second surgery to remove the hardware, which minimizes the probability of re-diastasis. Since our results showed no statistical difference between single and double interosseous suture endobutton systems, the less costly single endobutton system may be the better alternative.     

Nochmals Hämoglobinbestimmung mit Reduziertem Hämoglobin

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