[Availability of patient information in the emergency department : Wish and reality]. / Verfügbarkeit von Patienteninformationen in der Notaufnahme : Wunsch und Wirklichkeit.

BACKGROUND: Fast access to information from other healthcare service providers is particularly important in emergency medicine, as the patients are often unknown and treatment decisions have to be made promptly. OBJECTIVES: The study aims to identify the challenges that emergency departments face in obtaining information on patient history, the expected benefits of easier access to information and which information is most urgently needed. MATERIALS AND METHODS: An online survey throughout Germany was carried out among medical staff working in emergency departments. In all, 181 questionnaires were fully completed and could be included in the data analysis. RESULTS: Of the respondents, 77.9% said it was difficult or very difficult to receive external data at the point of patient care. The survey participants estimate that they need an average of around 47 min to obtain information about one patient. 99.4% believe that patient care would benefit from an easier and faster information exchange. Medication lists, discharge letters, information on previous illnesses and allergies were classified as the most important data elements. CONCLUSIONS: There is an urgent need for action with regard to the considerable effort involved in obtaining information on emergency patients. Digital solutions such as the recently introduced emergency data set can offer additional value for clinical emergency care if they are widely used.

Vector-apodizing phase plate coronagraph: design, current performance, and future development [Invited].

Over the last decade, the vector-apodizing phase plate (vAPP) coronagraph has been developed from concept to on-sky application in many high-contrast imaging systems on 8 m class telescopes. The vAPP is a geometric-phase patterned coronagraph that is inherently broadband, and its manufacturing is enabled only by direct-write technology for liquid-crystal patterns. The vAPP generates two coronagraphic point spread functions (PSFs) that cancel starlight on opposite sides of the PSF and have opposite circular polarization states. The efficiency, that is, the amount of light in these PSFs, depends on the retardance offset from a half-wave of the liquid-crystal retarder. Using different liquid-crystal recipes to tune the retardance, different vAPPs operate with high efficiencies (${\gt}96\%$) in the visible and thermal infrared (0.55 µm to 5 µm). Since 2015, seven vAPPs have been installed in a total of six different instruments, including Magellan/MagAO, Magellan/MagAO-X, Subaru/SCExAO, and LBT/LMIRcam. Using two integral field spectrographs installed on the latter two instruments, these vAPPs can provide low-resolution spectra (${\rm{R}} \sim 30$) between 1 µm and 5 µm. We review the design process, development, commissioning, on-sky performance, and first scientific results of all commissioned vAPPs. We report on the lessons learned and conclude with perspectives for future developments and applications.

CaRdiac Arrest Survival Score (CRASS) - A tool to predict good neurological outcome after out-of-hospital cardiac arrest.

AIM: The aim of this study was to develop a score to predict the outcome for patients brought to hospital following out-of-hospital cardiac arrest (OHCA). METHODS: All patients recorded in the German Resuscitation Registry (GRR) who suffered OHCA 2010-2017, who had ROSC or ongoing CPR at hospital admission were included. The study population was divided into development (2010-2016: 7985) and validation dataset (2017: 1806). Binary logistic regression analysis was used to derive the score. The probability of hospital discharge with good neurological outcome was defined as 1/(1 + e-X), where X is the weighted sum of independent variables. RESULTS: The following variables were found to have a significant positive (+) or negative (-) impact: age 61-70 years (-0·5), 71-80 (-0·9), 81-90 (-1·3) and > = 91 (-2·3); initial PEA (-0·9) and asystole (-1·4); presumable trauma (-1·1); mechanical CPR (-0·3); application of adrenalin > 0 - < 2 mg (-1·1), 2 - <4 mg (-1·6), 4 - < 6 mg (-2·1), 6 - < 8 mg (-2·5) and > = 8 mg (-2·8); pre emergency status without previous disease (+0·5) or minor disease (+0·2); location at nursing home (-0·6), working place/school (+0·7), doctor's office (+0·7) and public place (+0·3); application of amiodarone (+0·4); hospital admission with ongoing CPR (-1·9) or normotension (+0·4); witnessed arrest (+0·6); time from collapse until start CPR 2 - < 10 min (-0·3) and > = 10 min (-0·5); duration of CPR <5 min (+0·6). The AUC in the development dataset was 0·88 (95% CI 0·87-0·89) and in the validation dataset 0·88 (95% CI 0·86-0·90). CONCLUSION: The CaRdiac Arrest Survival Score (CRASS) represents a tool for calculating the probability of survival with good neurological function for patients brought to hospital following OHCA.

Bystander-witnessed cardiac arrest is associated with reported agonal breathing and leads to less frequent bystander CPR.

AIM: Although the importance of bystander cardiopulmonary resuscitation has been shown in multiple studies, the rate of bystander cardiopulmonary resuscitation is still relatively low in many countries. Little is known on bystanders' perceptions influencing the decision to start cardiopulmonary resuscitation. Our study aims to determine such factors. MATERIALS AND METHODS: Semi-structured telephone interviews with bystanders of out-of-hospital cardiac arrests between December 2014 and April 2016 were performed in a prospective manner. This single-center survey was conducted in the city of Münster, Germany. The bystander's sex and age, the perception of the victim's breathing and initial condition were correlated with the share of bystander cardiopulmonary resuscitation in the corresponding group. RESULTS: 101 telephone interviews were performed with 57 male and 44 female participants showing a mean age of 52.7 (SD ±â€¯16.3). In case of apnoea 38 out of 46 bystanders (82.6%) started cardiopulmonary resuscitation; while in case of descriptions indicating agonal breathing 19 out of 35 bystanders (54.3%) started cardiopulmonary resuscitation (p = .007). If the patient was found unconscious 47 out of 63 bystanders (74.7%) performed cardiopulmonary resuscitation, while in cases of witnessed cardiac arrest 19 out of 38 bystanders (50%) attempted cardiopulmonary resuscitation (p = .012). Witnessed change of consciousness is an independent factor significantly lowering the probability of starting cardiopulmonary resuscitation (regression coefficient -1.489, p < .05). CONCLUSION: The witnessed loss of consciousness was independently associated with a significant reduction in the likelihood that bystander-CPR was started. These data reinforce the importance of teaching the recognition of early cardiac arrest.

Out-of-hospital airway management during manual compression or automated chest compression devices : A registry-based analysis.

BACKGROUND: Airway management during resuscitation is pivotal for treating hypoxia and inducing reoxygenation. This German Resuscitation Registry (GRR) analysis investigated the influence of the type of airway used in patients treated with manual chest compression (mCC) and automated chest compression devices (ACCD) after out-of-hospital cardiac arrest (OHCA). METHODS: Out of 42,977 patients (1 January 2010-30 June 2016) information on outcome, airway management and method of chest compressions were available for 27,544 patients. Hospital admission under cardiopulmonary resuscitation (CPR), hospital admission with return of spontaneous circulation (ROSC), hospital discharge and discharge with cerebral performance categories 1 and 2 (CPC 1,2) were used to compare outcome in patients treated with mCC vs. ACCD, and classified by endotracheal intubation (ETI), initial supraglottic airway device (SAD) changed into ETI, and only SAD use. RESULTS: Outcomes for hospital admission under ongoing CPR, hospital admission with ROSC, hospital discharge and neurologically intact survival (CPC 1,2) for mCC (84.8%) vs. ACCD (15.2%) groups were: 8.4/38.6%, 39.2/27.2%, 10.6/6.8%, 7.9/4.7% (p < 0.001), respectively. Only mCC with SAD/ETI for ever ROSC (OR 1.466, 95% CI: 1.353-1.588, p < 0.001) and mCC group with SAD/ETI for hospital admission with ROSC showed better outcomes (odds ratio [OR] 1.277, 95% confidence interval [CI]: 1.179-1.384, p < 0.001) in comparison to mCC treated with ETI. Compared to mCC/ETI, all other groups were associated with a decrease in neurologically intact survival. CONCLUSION: Better outcomes were found for mCC in comparison to ACCD and ETI showed better outcomes in comparison to SAD only. This observational registry study raised the hypothesis that SAD only should be avoided or SAD should be changed into ETI, independent of whether mCC or ACCD is used.

[Clinical practice of systemic lysis in prehospital resuscitation. Success and complication rates]. / Klinische Praxis der systemischen Lyse unter prähospitaler Reanimation. Erfolgs- und Komplikationsraten.

BACKGROUND: Systemic thrombolysis was introduced as the sole prehospital treatment option in patients with cardiac arrest in the setting of acute myocardial ischemia or pulmonary embolism; however, it remains the subject of discussion. PATIENTS AND METHODS: A total of 194 patients with sudden prehospital cardiac arrest were included in this retrospective case control study. Of these patients, 96 in whom circulatory arrest due to cardiac disease (pulmonary artery embolism or myocardial ischemia) was suspected underwent thrombolytic treatment and were compared to the remaining 98 patients that did not undergo thrombolytic therapy. In addition to the circumstances of circulatory arrest, the course and success of resuscitation, as well as in-hospital course (including bleeding complications), overall survival and neurological outcomes were compared. RESULTS: There were no significant differences between patients with or without thrombolysis in terms of the circumstances of cardiac arrest. Patients that received thrombolytic treatment were significantly younger and were more frequently treated with anticoagulants, platelet aggregation inhibitors and amiodarone. They also received higher doses of epinephrine and arrived at hospital under ongoing resuscitation significantly more frequently. A trend toward more prehospital return of spontaneous circulation (ROSC) following thrombolytic treatment was seen in the entire cohort. However, patients pre-treated with acetylsalicylic acid and heparin did not show better prehospital ROSC rates as a result of additional thrombolytic therapy. Significant differences in terms of bleeding complications or the need for blood transfusion could not be seen due to the small number of patients. DISCUSSION: The indication for systemic thrombolysis in the context of prehospital resuscitation should remain restricted to patients with clear symptoms of acute pulmonary embolism or recurrent episodes of ventricular fibrillation in the setting of acute myocardial infarction. Due to a lack of evidence, systemic thrombolysis should not be used as a treatment of last resort in younger patients with persistent ventricular fibrillation.

[German resuscitation registry : science and resuscitation research]. / Deutsches Reanimationsregister : Wissenschaft und Reanimationsforschung.

Sudden death due to cardiac arrest represents one of the greatest challenges facing modern medicine, not only because of the massive number of cases involved but also because of its tremendous social and economic impact. For many years, the magic figure of 1 per 1000 inhabitants per year was generally accepted as an estimate of the annual incidence of sudden death in the industrialized world, with a survival rate of 6 %. This estimate was based on large numbers of published reports of local, regional, national and multinational experience in the management of cardiac arrest. Measuring the global incidence of cardiac arrest is challenging as many different definitions of patient populations are used. Randomized controlled trials (RCT) provide insights into the value of specific treatments or treatment strategies in a well-defined section of a population. Registries do not compete with clinical studies, but represent a useful supplement to them. Surveys and registries provide insights into the ways in which scientific findings and guidelines are being implemented in clinical practice. However, as with clinical studies, comprehensive preparations are needed in order to establish a registry. This is all the more decisive because not all of the questions that may arise are known at the time when the registry is established. The German resuscitation registry started in May 2007 and currently more than 230 paramedic services and hospitals take part. More than 45,000 cases of out-of-hospital cardiac arrest and in-hospital cardiac arrest are included. With this background the German resuscitation registry is one of the largest databases in emergency medicine in Germany. After 5 years of running the preclinical care dataset was revised in 2012. Data variables that reflect current or new treatment were added to the registry. The postresuscitation basic care and telephone cardiopulmonary resuscitation (CPR) datasets were developed in 2012 and 2013 as well. The German resuscitation registry is an instrument of quality management and a research network. The registry documents the course in patients who have undergone resuscitation at the time points of first aid, further management and long-term outcome and it can therefore provide a complete presentation of the procedures carried out and the quality of the outcomes. In addition, important scientific questions can be answered from the database. For example, a score for benchmarking the outcome quality after out-of-hospital resuscitation, known as the return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score, has been developed. The registry is available for all emergency medical services (EMS) and hospitals in Germany and other German-speaking countries.

Evaluation of four point-of-care glucose meters in alpacas.

PURPOSE: Hospitalized alpacas are often hyperglycemic requiring frequent blood glucose testing. OBJECTIVES: To compare the performance of 4 brands of glucometers with a laboratory-based analyzer (LCA) over a range of glucose concentrations in alpacas. ANIMALS: Four healthy male alpacas. METHODS: A 2-treatment cross-over study was utilized. The alpacas were given 0.4 U/kg of regular insulin intravenously and then 500 mg/kg of dextrose intravenously with a 1 week washout period between treatments. Blood samples were collected from 10 minutes before until 6 hours after drug administration. Glucose concentrations were measured in whole blood and plasma samples on 4 glucometers, and serum glucose was measured on an LCA. RESULTS: Glucometer performance varied depending on whether glucose concentrations were measured in plasma or whole blood. Based on error grid analysis, the Precision Xtra and One Touch Ultra 2 glucometers were clinically acceptable for testing whole blood samples, whereas the Accu-Chek Aviva and Nova StatStrip Xpress glucometers were clinically acceptable for testing plasma samples in comparison with serum glucose concentrations determined by the LCA. All glucometers had systematic and proportional biases that varied based on sample type. CONCLUSIONS AND CLINICAL IMPORTANCE: Human-based glucometers in alpacas should be used cautiously, particularly at higher blood glucose concentrations. The blood sample type (plasma or whole blood) can alter meter performance when compared with serum glucose concentrations and potentially lead to errors in clinical decisions.

[Stroke always with an emergency physician? - Pro]. / "Schlaganfall immer mit Notarzt?" - "Pro".

Good management of acute stroke is dependent on time and expertise. In Germany emergency medical care by ambulance services sometimes occurs without an emergency physician being sent to the scene. By reviewing current literature the question of patient care in the ambulance with or without an emergency physician is discussed. Presence of an emergency physician at the scene results in high diagnostic accuracy, allows for invasive procedures to be carried out, and enables referral to a specialist centre with a stroke-unit. The "rendezvous" system of separate deployment of patient ambulance and emergency physician allow flexible assignment of the physician resulting in short response times. Current research does not support a turn away from the deployment of an emergency physician in cases of acute stroke.

Teaching resuscitation in schools: annual tuition by trained teachers is effective starting at age 10. A four-year prospective cohort study.

AIMS: Evaluation of school pupils' resuscitation performance after different types of training relative to the effects of training frequency (annually vs. biannually), starting age (10 vs. 13 years) and facilitator (emergency physician vs. teacher). METHODS: Prospective longitudinal study investigating 433 pupils in training and control groups. Outcome criteria were chest compression depth, compression frequency, ventilation volume, ventilation frequency, self-image and theoretical knowledge. In the training groups, 251 pupils received training annually or biannually either from emergency physicians or CPR-trained teachers. The control group without any training consisted of 182 pupils. RESULTS: Improvements in training vs. control groups were observed in chest compression depth (38 vs. 24 mm), compression frequency (74 vs. 42 min(-1)), ventilation volume (734 ml vs. 21 ml) and ventilation frequency (9/min vs. 0/min). Numbers of correct answers in a written test improved by 20%, vs. 5% in the control group. Pupils starting at age 10 showed practical skills equivalent to those starting at age 13. Theoretical knowledge was better in older pupils. Self-confidence grew in the training groups. Neither more frequent training nor training by emergency physicians led to better performance among the pupils. CONCLUSIONS: Pupils starting at age 10 are able to learn cardiopulmonary resuscitation with one annual training course only. After a 60-min CPR-training update, teachers are able to provide courses successfully. Early training reduces anxieties about making mistakes and markedly increases participants' willingness to help. Courses almost doubled the confidence of pupils that what they had learned would enable them to save lives.

[Concept for allocation of acute stroke patients: evaluation of the quality of diagnosis reached by the emergency medical services of Münster]. / Zuweisungskonzept bei akutem Schlaganfall : Untersuchung der rettungsdienstlichen Diagnosequalität in der Stadt Münster.

BACKGROUND: Acute stroke is a time- and expertise-critical emergency. An immediate and correct diagnosis by emergency medical services (EMS) in the prehospital phase and patient transfer to the nearest adequate hospital with a stroke unit is required for early treatment of acute stroke. PATIENTS AND METHODS: We evaluated all patients who were admitted by the EMS of Münster to one of the two stroke units in the town between October 2008 and December 2010 with a diagnosis of acute stroke. Furthermore all patients were critically analyzed who were admitted without a diagnosis of acute stroke by the EMS but nonetheless had a stroke and the correct diagnosis was not found until examination in the neurological department. RESULTS: We analyzed 615 patients who were admitted to the stroke units with the diagnosis of acute stroke. In 561 cases (91%) this diagnosis could be confirmed, but in 54 patients (9%) the diagnosis by the EMS was incorrect. Epileptic seizure was the most frequent false-positive diagnosis in this group of patients (39%; n = 21). Although the acute symptoms were caused by a stroke, the correct diagnosis was not defined by the EMS in 127 patients. This accounted for 18% of all patients admitted to the emergency departments by the EMS where ultimately a stroke was diagnosed. In 24% of these cases (n = 30) the emergency doctor missed the correct diagnosis, which meant 4% of all patients admitted by the EMS, finally diagnosed with an acute stroke. In all other cases in the group with a false-negative diagnosis (76% or 97 patients) an emergency doctor was not involved in the referral by the EMS. CONCLUSION: Emergency medical services should be involved in the establishment of admission programs for acute stroke patients to provide the fastest means of transportation to a stroke unit. Coma, symptoms of posterior cerebral circulation and epileptic seizures cause difficulties in ensuring an immediate and correct diagnosis. Sending an emergency doctor to the scene increases diagnostic certainty which is essential to initiate early treatment.

Localization of canine, feline, and mouse renal membrane proteins.

Immunohistochemistry allows the localization of proteins to specific regions of the nephron. This article reports the identification and localization of proteins in situ within normal canine, feline, and mouse kidney by immunohistochemistry; maps their distribution; and compares results to previously reported findings in other species. The proteins investigated are aquaporin 1, aquaporin 2, calbindin D-28k, glutathione S-transferase-α, and Tamm-Horsfall protein. Aquaporins are integral membrane proteins involved in water transport across cell membranes. Calbindin D-28k is involved in renal calcium metabolism. Glutathione S-transferase-α is a protein that aids in detoxification and drug metabolism. The role of Tamm-Horsfall protein is not fully understood. Proposed functions include inhibition of calcium crystallization and reduction of bacterial urinary tract infection. The authors' findings in the dog are similar to those in other species: Specifically, the authors localize aquaporin 1 to the proximal convoluted tubule epithelium, vasa recta endothelium, and descending thin limbs; aquaporin 2 to collecting duct epithelium; and calbindin D-28k within distal convoluted tubule epithelium. Glutathione S-transferase-α has variable expression and is found in only the renal transitional epithelium in some individuals, in only the proximal straight tubules in others, or in both locations in others. Tamm-Horsfall protein localizes to thick ascending limb epithelium. These findings are similar in the cat, with the exception that aquaporin 1 is located in glomerular podocytes, in addition to proximal convoluted tubule epithelium, and glutathione S-transferase-α is found solely within the proximal convoluted tubule within all kidney samples examined. The mouse kidney is almost identical to the dog but expresses glutathione S-transferase-α in the glomeruli only.

[Do sociodemographic factors influence emergency medical missions? : analysis in the City of Münster]. / Beeinflussen soziodemografische Faktoren Notarzteinsätze? : Analyse in der Stadt Münster.

BACKGROUND: Demographic development and changes in healthcare utilization have led to a rising number of calls for emergency services. In Germany life-threatening situations are responded by physician-staffed ambulances in a 2-tier system whereas paramedic-staffed ambulances are dispatched in non-life-threatening emergencies. A nationwide protocol guides dispatchers in triage decisions. In the years 1999 to 2009 a continuous rise in the number of calls for a physician-staffed ambulance in Münster was recorded. The degree of healthcare utilization according to socioeconomic status and age structure was retrospectively examined. METHODS: For the year 2006 all emergency calls in the City of Münster responded to by physician-staffed ambulances were analyzed. Each call was assigned to 1 of the 45 urban districts. The local incidence of emergency calls (calls/100 residents/year) was determined and compared to the socioeconomic status which was defined as the percentage of welfare and unemployment benefit recipients per district. Patient condition was assessed by the Munich National Advisory Committee for Aeronautics (M-NACA) score. This scoring system allows calls to be allocated to either life-threatening conditions or non-life-threatening conditions by objective vital parameters. The age structure of the emergency callers was also examined. RESULTS: Urban districts with a low socioeconomic status showed a higher incidence of emergency calls requiring physician-staffed ambulance responses than districts with a high socioeconomic status. Measured by the M-NACA scoring system, the fraction of life-threatening emergencies among all calls proved to be equal to districts with a high socioeconomic status. A correlation between elderly patients and increasing numbers of life-threatening emergencies was found. CONCLUSIONS: A low socioeconomic status of an urban district will result in more ambulance responses. However, the proportion of life-threatening emergencies is equal to districts with a high socioeconomic status. Thus, the greater need for physician-staffed ambulance responses matches clinical needs and legitimates current resource use in a 2-tier ambulance system. Indications for the abuse of physician-staffed ambulances were not found. Considering an aging population the number of emergency calls will rise in the future.

[Real-time feedback systems for improvement of resuscitation quality]. / Echtzeit-Feedback-Systeme zur Verbesserung der Reanimationsqualität.

The quality of chest compression is a determinant of survival after cardiac arrest. Therefore, the European Resuscitation Council (ERC) 2010 guidelines on resuscitation strongly focus on compression quality. Despite its impact on survival, observational studies have shown that chest compression quality is not reached by professional rescue teams. Real-time feedback devices for resuscitation are able to measure chest compression during an ongoing resuscitation attempt through a sternal sensor equipped with a motion and pressure detection system. In addition to the electrocardiograph (ECG) ventilation can be detected by transthoracic impedance monitoring. In cases of quality deviation, such as shallow chest compression depth or hyperventilation, feedback systems produce visual or acoustic alarms. Rescuers can thereby be supported and guided to the requested quality in chest compression and ventilation. Feedback technology is currently available both as a so-called stand-alone device and as an integrated feature in a monitor/defibrillator unit. Multiple studies have demonstrated sustainable enhancement in the education of resuscitation due to the use of real-time feedback technology. There is evidence that real-time feedback for resuscitation combined with training and debriefing strategies can improve both resuscitation quality and patient survival. Chest compression quality is an independent predictor for survival in resuscitation and should therefore be measured and documented in further clinical multicenter trials.

1H-NMR analysis of water mobility in cultured phototrophic biofilms.

The present work reports on the first attempt to study water mobility in phototrophic biofilms, applying the (1)H-NMR relaxometry technique to closely monitored microbial communities grown in a microcosm under controlled ambient conditions. Longitudinal water proton relaxation times exhibited a bi-exponential behavior in all biofilm samples, indicating two types of water molecules with diverging dynamic properties, confined to different compartments of the biofilm. The fast-relaxing component can be attributed to water molecules tightly bound to the intracellular matrix, while the slow-relaxing component could reflect the behavior of water embedded in the biopolymer matrix, confined into matrix pores and channels. The results are discussed with respect to a possible key role of exopolysaccharides and uronic acids in water binding in phototrophic biofilms.

The effect of IgG levels on the number of natural killer cells and their Fc receptors in chronic inflammatory demyelinating polyradiculoneuropathy.

BACKGROUND AND PURPOSE: High-dose intravenous immunoglobulin (IVIg) is an established treatment for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Although Fc receptors on natural killer cells have been suggested as a target for IVIg, the pharmacological effects are not yet clarified. We hypothesize that IVIg therapy, dependent on the plasma IgG level, suppresses the cytotoxic capacity by a reduction in numbers of NK cells and their Fc receptor CD16. PATIENTS AND METHODS: Ten consecutive patients with CIDP in maintenance therapy with IVIg were studied before and immediately after the infusion of 0.7-2.0 g/kg IVIg. Peripheral blood mononuclear cell samples from these patients were analyzed immediately after isolation using flow cytometry and cytotoxicity assays. RESULTS: We found that following IVIg treatment, the cytotoxic activity of NK cells in CIDP patients was suppressed, partly caused by a dose-dependent decline in the number of circulating NK cells. In addition, a dose-dependent blockage of CD16 occurred. CONCLUSIONS: The study implies that IVIg infusion induces a substantial decline in the number of peripheral NK cells and a suppression of NK-cell-mediated cytotoxicity. We propose that these impairments of the NK cells contribute to the therapeutic effect of IVIg in CIDP.

[Chest compression quality : Can feedback technology help?]. / Thoraxkompressionsqualität : Hilft Feedback-Technologie?

BACKGROUND: The outcome of cardiopulmonary resuscitation (CPR) depends on the quality of chest compressions. Current European Resuscitation Council (ERC) guidelines promote the development of feedback systems. However, no studies presenting satisfactory results of feedback use have been published. METHODS: A total of 60 patients with cardiac arrest (> or =18 years of age) received resuscitation attempts using an automated external defibrillator (AED) with real-time feedback by the ambulance service of the City of Münster. The frequency of chest compressions, no-flow time (NFT) and depth of chest compressions were analyzed for the first three cycles of CPR and compared to the ERC guidelines 2005. RESULTS: Chest compression frequency did not differ significantly from the ideal as set out in the guidelines. Analysis of NFTs showed significantly longer NFT for the first cycle but NFT for the second and third cycles did not differ significantly from the ideal. The target depth of 4-5 cm was achieved in 80% of all chest compressions in the first 3 cycles. CONCLUSION: With the AED real-time feedback technology used in this study standardized performance of chest compressions could be maintained in a professional ambulance service. Implementation of a feedback system requires training of ambulance staff.

Vascular targeting therapy: potential benefit depends on tumor and host related effects.

The growth and development of most solid tumors require that they form their own functional vascular supply, which they do from the host normal vascular network by the process of angiogenesis. The significance of this neo-vasculature makes it an excellent target and two forms of vascular targeting agents (VTAs) have evolved; those that inhibit the angiogenesis process (angiogenesis inhibitors, AIs) and those that damage the already established vessels (vascular disrupting agents, VDAs). Although both AIs and VDAs can have substantial anti-tumor activity, neither induce tumor control, thus for their full clinical potential to be achieved they will need to be combined with more conventional cancer therapies. Numerous pre-clinical studies have demonstrated the efficacy of combining AIs and VDAs with radio- and chemo-therapy and many of these approaches are now under clinical evaluation. Although the tumor is the target for VTA therapy the normal host cells play an important role in VTA efficacy. Host cells such as infiltrating macrophages, neutrophils, mast cells, platelets, endothelial cells, and stromal fibroblasts can all produce the important growth factors that initiate angiogenesis. Many of these host cells also actively participate in the physical steps of angiogenesis including destabilization of existing vessels, blood vessel sprouting, endothelial cell migration and proliferation, and vessel stabilization. There is some evidence that these host cells can also influence VTA treatment, either by helping to normalize tumor vessels when AIs are administered or stimulate tumor angiogenesis after treatment with VDAs. The host itself also plays a critical role. Cancer patients undergoing therapy are normally treated to tolerance, thus the normal tissue side effects actually control the effective dose given to the tumor. All VTAs currently in clinical development induce some form of systemic side effects, which range from being rather mild and tolerable to more severe and even life threatening. For more localised therapies there is also the issue of possible VTA-enhanced local tissue reactions. A few pre-clinical studies have investigated this with radiation, but failed to show any enhancement of radiation-induced normal tissue damage by VTAs. Clearly, the therapeutic benefit of VTA treatment will depend on a balance between tumor and host related effects, and in this review we will consider the contribution of each.

Embryo-toxic effects of environmental concentrations of chlorpyrifos on the crustacean Daphnia magna.

Chlorpyrifos is a non-systemic organophosphorus insecticide leading to the inhibition of the enzyme cholinesterase. Nowadays, this insecticide is widely used on a variety of crops and is frequently detected in surface waters around the world. The main aims of this study were to evaluate the effects of this insecticide on the embryonic development of Daphnia magna, and to assess the sensitivity of this endpoint in comparison with the endpoint of the chronic 21-day test. The featured endpoints were the number of offspring per female and abnormalities of both offspring and embryos. Chlorpyrifos exhibited significant toxic effects on the embryonic development manifested in the appearance of abnormalities, including arrested eggs, in 20% of the embryos exposed to a concentration of 0.01 microgL(-1). Furthermore, chronic exposition to the insecticide yielded a proportion of offspring abnormalities in later stages of development of about 43% at 0.01 microgL(-1). In contrast, a significant reduction in the number of offspring produced per female was only observed above a concentration of 0.03 microgL(-1). Hence, these results suggest that developmental abnormality was a more sensitive endpoint than the number of offspring production per female.