Impaired local production of proresolving lipid mediators in obesity and 17-HDHA as a potential treatment for obesity-associated inflammation.

Obesity-induced chronic low-grade inflammation originates from adipose tissue and is crucial for obesity-driven metabolic deterioration, including insulin resistance and type 2 diabetes. Chronic inflammation may be a consequence of a failure to actively resolve inflammation and could result from a lack of local specialized proresolving lipid mediators (SPMs), such as resolvins and protectins, which derive from the n-3 polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). We assessed obesity-induced changes of n-3-derived SPMs in adipose tissue and the effects of dietary EPA/DHA thereon. Moreover, we treated obese mice with SPM precursors and investigated the effects on inflammation and metabolic dysregulation. Obesity significantly decreased DHA-derived 17-hydroxydocosahexaenoic acid (17-HDHA, resolvin D1 precursor) and protectin D1 (PD1) levels in murine adipose tissue. Dietary EPA/DHA treatment restored endogenous biosynthesis of n-3-derived lipid mediators in obesity while attenuating adipose tissue inflammation and improving insulin sensitivity. Notably, 17-HDHA treatment reduced adipose tissue expression of inflammatory cytokines, increased adiponectin expression, and improved glucose tolerance parallel to insulin sensitivity in obese mice. These findings indicate that impaired biosynthesis of certain SPM and SPM precursors, including 17-HDHA and PD1, contributes to adipose tissue inflammation in obesity and suggest 17-HDHA as a novel treatment option for obesity-associated complications.

Effective compression ratio--a new measurement of the quality of thorax compression during CPR.

PURPOSE: Computer-based feedback systems for assessing the quality of cardiopulmonary resuscitation (CPR) are widely used these days. Recordings usually involve compression and ventilation dependent variables. Thorax compression depth, sufficient decompression and correct hand position are displayed but interpreted independently of one another. We aimed to generate a parameter, which represents all the combined relevant parameters of compression to provide a rapid assessment of the quality of chest compression-the effective compression ratio (ECR). METHODS: The following parameters were used to determine the ECR: compression depth, correct hand position, correct decompression and the proportion of time used for chest compressions compared to the total time spent on CPR. Based on the ERC guidelines, we calculated that guideline compliant CPR (30:2) has a minimum ECR of 0.79. To calculate the ECR, we expanded the previously described software solution. In order to demonstrate the usefulness of the new ECR-parameter, we first performed a PubMed search for studies that included correct compression and no-flow time, after which we calculated the new parameter, the ECR. RESULTS: The PubMed search revealed 9 trials. Calculated ECR values ranged between 0.03 (for basic life support [BLS] study, two helpers, no feedback) and 0.67 (BLS with feedback from the 6th minute). CONCLUSION: ECR enables rapid, meaningful assessment of CPR and simplifies the comparability of studies as well as the individual performance of trainees. The structure of the software solution allows it to be easily adapted to any manikin, CPR feedback devices and different resuscitation guidelines (e.g. ILCOR, ERC).

Long-chain n-3 PUFAs reduce adipose tissue and systemic inflammation in severely obese nondiabetic patients: a randomized controlled trial.

BACKGROUND: Chronic adipose tissue inflammation is a hallmark of obesity, triggering the development of associated pathologies, particularly type 2 diabetes. Long-chain n-3 PUFAs reduce cardiovascular events and exert well-established antiinflammatory effects, but their effects on human adipose tissue inflammation are unknown. OBJECTIVE: We investigated whether n-3 PUFAs reduce adipose tissue inflammation in severely obese nondiabetic patients. DESIGN: We treated 55 severely obese nondiabetic patients, scheduled to undergo elective bariatric surgery, with 3.36 g long-chain n-3 PUFAs/d (EPA, DHA) or an equivalent amount of butterfat as control, for 8 wk, in a randomized open-label controlled clinical trial. The primary efficacy measure was inflammatory gene expression in visceral and subcutaneous adipose tissue samples (subcutaneous adipose tissue and visceral adipose tissue), collected during surgery after the intervention. Secondary efficacy variables were adipose tissue production of antiinflammatory n-3 PUFA-derived eicosanoids, plasma concentrations of inflammatory markers, metabolic control, and the effect of the Pro12Ala PPARG polymorphism on the treatment response. RESULTS: Treatment with n-3 PUFAs, which was well tolerated, decreased the gene expression of most analyzed inflammatory genes in subcutaneous adipose tissue (P < 0.05) and increased production of antiinflammatory eicosanoids in visceral adipose tissue and subcutaneous adipose tissue (P < 0.05). In comparison with control subjects who received butterfat, circulating interleukin-6 and triglyceride concentrations decreased significantly in the n-3 PUFA group (P = 0.04 and P = 0.03, respectively). The Pro12Ala polymorphism affected the serum cholesterol response to n-3 PUFA treatment. CONCLUSIONS: Treatment with long-chain n-3 PUFAs favorably modulated adipose tissue and systemic inflammation in severely obese nondiabetic patients and improved lipid metabolism. These effects may be beneficial in the long-term treatment of obesity. This trial was registered at clinicaltrials.gov as NCT00760760.

Effects and limitations of an AED with audiovisual feedback for cardiopulmonary resuscitation: a randomized manikin study.

PURPOSE: Correctly performed basic life support (BLS) and early defibrillation are the most effective measures to treat sudden cardiac arrest. Audiovisual feedback improves BLS. Automated external defibrillators (AED) with feedback technology may play an important role in improving CPR quality. The aim of this simulation study was to investigate if an AED with audiovisual feedback improves CPR parameters during standard BLS performed by trained laypersons. METHODS: With ethics committee approval and informed consent, 68 teams (2 flight attendants each) performed 12 min of standard CPR with the AED's audiovisual feedback mechanism enabled or disabled. We recorded CPR quality parameters during resuscitation on a manikin in this open, prospective, randomized controlled trial. Between the feedback and control-group we measured differences in compression depth and rate as main outcome parameters and effective compressions, correct hand position, and incomplete decompression as secondary outcome parameters. An effective compression was defined as a compression with correct depth, hand position, and decompression. RESULTS: The feedback-group delivered compression rates closest to the recommended guidelines (101 ± 9 vs. 109 ± 15/min, p=0.009), more effective compressions (20 ± 18 vs. 5 ± 6%, p<0.001), more compressions with correct hand position (96 ± 13 vs. 88 ± 16%, p<0.001), and less leaning (21 ± 31 vs. 77 ± 33%, p<0.001). However, only the control-group adhered to the recommended compression depth (44 ± 7 mm vs. 39 ± 6, p=0.003). CONCLUSION: Use of an AED's audiovisual feedback system improved some CPR-quality parameters, thus confirming findings of earlier studies with the notable exception of decreased compression depth, which is a key parameter that might be linked to reduced cardiac output.

A manually powered mechanical resuscitation device used by a single rescuer: a randomised controlled manikin study.

PURPOSE: The goal of this randomized, open, controlled crossover manikin study was to compare the performance of "Animax", a manually operated hand-powered mechanical resuscitation device (MRD) to standard single rescuer basic life support (BLS). METHODS: Following training, 80 medical students performed either standard BLS or used an MRD for 12 min in random order. We compared the quality of chest compressions (effective compressions, compression depth and rate, absolute hands-off time, hand position, decompression), and of ventilation including the number of gastric inflations. An effective compression was defined as a compression performed with correct depth, hand position and decompression. RESULTS: The use of the MRD resulted in a significantly higher number of effective compressions compared to standard BLS (67 ± 34 vs. 41 ± 34%, p<0.001). In a comparison with standard BLS, the use of the MRD resulted in less absolute hands-off time (264 ± 57 vs. 79 ± 40 s, p<0.001) and in a higher minute-volume (1.86 ± 0.7 vs. 1.62 ± 0.7 l, p=0.020). However, ventilation volumes were below the 2005 ERC guidelines for both methods. Gastric inflations occurred only in 0 ± 0.1% with the MRD compared to 3 ± 7% during standard BLS (p<0.001). CONCLUSION: Single rescuer cardio-pulmonary resuscitation with the manually operated MRD was superior to standard BLS regarding chest compressions in this simulation study. The MRD delivered a higher minute-volume but did not achieve the recommended minimal volume. Further clinical studies are needed to test the MRD's safety and efficacy in patients.

Quality of resuscitation: flight attendants in an airplane simulator use a new mechanical resuscitation device--a randomized simulation study.

PURPOSE: Cardiopulmonary resuscitation (CPR) during flight is challenging and has to be sustained for long periods. In this setting a mechanical-resuscitation-device (MRD) might improve performance. In this study we compared the quality of resuscitation of trained flight attendants practicing either standard basic life support (BLS) or using a MRD in a cabin-simulator. METHODS: Prospective, open, randomized and crossover simulation study. Study participants, competent in standard BLS were trained to use the MRD to deliver both chest compressions and ventilation. 39 teams of two rescuers resuscitated a manikin for 12 min in random order, standard BLS or mechanically assisted resuscitation. Primary outcome was "absolute hands-off time" (sum of all periods during which no hand was placed on the chest minus ventilation time). Various parameters describing the quality of chest compression and ventilation were analysed as secondary outcome parameters. RESULTS: Use of the MRD led to significantly less "absolute hands-off time" (164±33 s vs. 205±42 s, p<0.001). The quality of chest compression was comparable among groups, except for a higher compression rate in the standard BLS group (123±14 min(-1) vs. 95±11 min(-1), p<0.001). Tidal volume was higher in the standard BLS group (0.48±0.14 l vs. 0.34±0.13 l, p<0.001), but we registered fewer gastric inflations in the MRD group (0.4±0.3% vs. 16.6±16.9%, p<0.001). CONCLUSION: Using the MRD resulted in significantly less "absolute hands-off time", but less effective ventilation. The translation of higher chest compression rate into better outcome, as shown in other studies previously, has to be investigated in another human outcome study.

Performance of supraglottic airway devices and 12 month skill retention: a randomized controlled study with manikins.

PURPOSE: Airway management for successful ventilation by laypersons and inexperienced healthcare providers is difficult to achieve. Bag-valve mask (BVM) ventilation requires extensive training and is performed poorly. Supraglottic airway devices (SADs) have been successfully introduced to clinical resuscitation practice as an alternative. We evaluated recently introduced (i-gel™ and LMA-Supreme™) and established SADs (LMA-Unique™, LMA-ProSeal™) and BVM used by laypeople in training sessions on manikins. METHODS: In this randomized controlled study, 267 third-year medical students participated with informed consent and IRB approval. After brief standardized training, each participant applied all devices in a randomized order. Success of device application and ventilation was recorded. Without further training, skill retention was assessed in the same manner 12 months later. Outcome parameters were the number of application attempts, application time, tidal volume and gastric inflation rate recorded at successful attempts, and subjective ease-of-use rating by the participants. RESULTS: i-gel™ and LMA-Supreme™ were the most successful in the first attempt at both assessments and in the subjective ease-of-use rating. The shortest application time was found with BVM (8 ± 5s in 2008 vs. 9 ± 5s in 2009) and i-gel (10 ± 3s vs. 12 ± 5s). Tidal volumes were disappointing with no device reaching 50% volume within the recommended range (0.4-0.6L). Gastric inflation rate was highest with BVM (18% vs. 20%) but significantly lower with all SADs (0.4-6%; p < 0.001 for 2008 and 2009). CONCLUSION: SADs showed clear advantages over BVM. Compared with LMA-Unique™ and LMA-ProSeal™, i-gel™ and LMA-Supreme™ led to higher first-attempt success rates and a shorter application time.