Does lack of thoracic trauma attenuate the severity of pulmonary failure? An 8-year analysis of critically injured patients

Abstract

Purpose

Patients with thoracic trauma are presumed to be at higher risk for pulmonary dysfunction, but adult respiratory distress syndrome (ARDS) may develop in any patient, regardless of associated chest injury. This study evaluated the impact of thoracic trauma and pulmonary failure on outcomes in trauma patients admitted to the intensive-care unit (ICU).

Methods

All trauma patients admitted to the ICU over an 8-year period were identified. Patients that died within 48 h of arrival were excluded. Patients were stratified by baseline characteristics, injury severity, development of ARDS, and infectious complications. Multiple logistic regression was used to determine variables significantly associated with the development of ARDS.

Results

10,362 patients were identified. After exclusions, 4898 (50%) patients had chest injury and 4975 (50%) did not. 200 (2%) patients developed ARDS (3.6% of patients with chest injury and 0.5% of patients without chest injury). Patients with ARDS were more likely to have chest injury than those without ARDS (87% vs 49%, p < 0.001). However, of the patients without chest injury, the development of ARDS still led to a significant increase in mortality compared to those patients without ARDS (58% vs 5%, p < 0.001). Multiple logistic regression found ventilator-associated pneumonia (VAP) to be the only independent predictor for the development of ARDS in ICU patients without chest injury.

Conclusions

ARDS development was more common in patients with thoracic trauma. Nevertheless, the development of ARDS in patients without chest injury was associated with a tenfold higher risk of death. The presence of VAP was found to be the only potentially preventable and treatable risk factor for the development of ARDS in ICU patients without chest injury.

http://bit.ly/2HOm1B3

An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy

Abstract

Objectives

The objectives of the study were to analyze the clinical characteristic of diabetic cheiroarthropathy (DCA) in patients with type 1 diabetes mellitus (DM), type 2 DM, and prediabetes and to evaluate the frequency of DCA among groups.

Method

The cross-sectional study was conducted at the Division of Endocrinology and Metabolism outpatient clinic over a 14-month period. A total of 239 patients (160 female, 79 male), who had type 1 DM, type 2 DM, and prediabetes, were enrolled. The demographics, clinical variables, and laboratory outcomes were recorded. Diabetic cheiroarthropathy was defined according to physical examination. The functional disability of patients with DCA was assessed by the self-administered questionnaire (disabilities of the arm, shoulder and hand-DASH).

Results

Diabetic cheiroarthropathy was determined in 35.1% of all patients. The frequency of DCA was higher in patients with prediabetes (x² = 0.009, post hoc power = 0.794). According to the logistic regression analysis, prediabetes (OR = 4.52, 95% CI 2.16–9.47, p < 0.001), presence of polyneuropathy (OR = 3.82, 95% CI 1.61–9.07, p = 0.002), and fasting glucose level (OR = 1.01, 95% CI 1.00–1.01, p = 0.004) found as the most effective risk factors in determining DCA. DASH disability scores were significantly higher in prediabetic patients than that in type 2 DM group (p = 0.021).

Conclusion

High frequency of DCA and impaired hand function are observed in prediabetic patients. Musculoskeletal manifestations can emerge as an early sign of diabetic status. Also, people who suffer from hand involvement should be examined for diabetes along with rheumatologic diseases.

http://bit.ly/2Shc17z

The impact of chlorophyllin on deoxynivalenol transport across jejunum mucosa explants obtained from adult pigs

Abstract

Regardless of the efforts put into preventing or reducing fungal growth, extensive mycotoxin contamination has been reported in animal feeds. In the case of pigs, one of the mycotoxins of major concern is deoxynivalenol (DON). The use of adsorbents as feed additives represents one of the strategies to control mycotoxins' contamination in feedstuff. Therefore, the aim of the study was to verify the ability of chlorophyllin (CHL) to reduce the absorption rate of DON in swine mucosa explants. Intestine was obtained from routinely slaughtered adult pigs. The mucosa explants were studied by means of Ussing chamber technique. The effect of DON (10 and 30 μg/ml) on mucosa viability and permeability and CHL (100 μg/ml) impact on DON (30 μg/ml) absorption was verified. The results revealed that mucosa explants isolated from adult animals remained unaffected for 90 min in the presence of DON in the lower concentration (10 μg/ml). Mycotoxin in the higher dose (30 μg/ml) increased mucosa permeability (decreased transepithelial electrical resistance value) and enhanced paracellular transport of lucifer yellow and mannitol but did not affect lactate dehydrogenase leakage. The introduction of CHL neither diminished the absorption rate of DON across swine mucosa explants nor prevented the toxic effects of DON on intestine. In conclusion, the results confirm the negative effect of DON on pig jejunum mucosa. However, the toxic effect of DON was observed only when it was used in relatively high doses. A promising adsorbent agent, CHL, failed to reduce the intensity of DON transport across intestine under in vitro conditions.

http://bit.ly/2GermiN

From the Editor-in-Chief

http://bit.ly/2MJXHz6

Virtual Reality-Based Time-Delayed Haptic Teleoperation Using Point Cloud Data

Abstract

This paper presents a methodology for bilateral teleoperation of robots based on the use of point cloud data obtained with an RGB-D camera for providing haptic feedback, as well as a virtual robot workspace that allows the user to interact with the teleoperated robot and the environment, regardless of the time-delay between the master device and the slave robot. The robot movements are executed first in the Virtual Workspace and then in the real one. The Virtual Workspace is created using point cloud data, and the haptic feedback is calculated directly using this data. The proposed methodology was validated in 2D and 3D trajectory-following experiments with 20 volunteers each teleoperating a KUKA industrial robot. In addition, we studied two inverse kinematic teleoperation modes: "Proportional Workspace" and "Delta end-effector movements", with the objective of determining which one is more suitable for the haptic teleoperation methodology proposed. The results obtained confirm that the proposed haptic teleoperation methodology enhances the precision of the operator by reducing the average error between the robot end-effector trajectory and the goal trajectory. Furthermore, the likelihood that the end-effector will collide with objects in the environment is reduced. The methodology also diminishes the time that it takes to complete the trajectory-following task in an unknown workspace. The inverse kinematic teleoperation mode with the better results is the "Proportional Workspace", which is more intuitive for operators (users).

http://bit.ly/2DN9OII

From the Editor-in-Chief

http://bit.ly/2ML315l

A clinical comparison of laparoscopic versus open appendectomy for the treatment of complicated appendicitis: historical cohort study

Abstract

Background

Appendectomy is one of the most common operations. Laparoscopic appendectomy (LA) is considered first-line treatment, but the use of LA for treatment of complicated appendicitis remains controversial. Here, we performed a retrospective analysis to compare clinical outcomes between patients treated with LA and those who underwent open appendectomy (OA).

Methods

Data for 179 patients who underwent an operation for the treatment of complicated appendicitis at our hospital between 2011 and 2017 were retrospectively analyzed. The selection included 89 patients who underwent a conventional appendectomy and 90 patients who were treated laparoscopically. Outcome measures such as mean operative time, blood loss, time until oral intake duration of hospital stay, and postoperative complications were analyzed. Logistic regression analysis was performed to determine the concurrent effects of the examined factors on the rate of postoperative complications.

Results

The mean ages of patients in the OA and LA groups were 50.17 ± 22.77 and 50.13 ± 25.84 year. Mean operative times were longer in the LA group than OA (10.2.56 ± 44.4 versus 85.4 ± 43.11 min; p = 0.009). The duration of hospital stay was shorter for the LA group (9.61 ± 5.57 versus 12.19 ± 8.4; p = 0.016). There were no significant differences in return to consumption of oral intake between the LA and OA groups (2.03 ± 1.66 versus 2.48 ± 2.17; p = 0.123). Multivariable analysis found that the rate of postoperative complications was significantly reduced for the LA group, in comparison with the postoperative-complication rate of the OA group (16.7% versus 27%; odds ratio 0.376; 95% CI 0.153–0.923; p = 0.0327).

Conclusions

These results suggest that LA is a safe and efficient operative procedure that provides clinically beneficial advantages in comparison with OA. Thus, when possible, appendectomy for complicated appendicitis should be attempted using a laparoscopic approach.

Trial registration

Retrospectively registered.

http://bit.ly/2Tss1AS

Unexpected immediate postoperative resolution of long-standing neurological deficits following extracranial-intracranial bypass: a report of three cases

Abstract

While intracranial ischemic insults often result in neuronal death and permanent neurological deficits, some patients may develop potentially reversible neurological dysfunction from persistent hypoperfusion, as surviving neurons remain in an "idling" state. We report a unique series of three patients with long-standing neurological deficits who underwent EC-IC bypass for repeated TIAs and demonstrated unexpected, rapid resolution of long-standing pre-existing neurological deficits. We suggest that these individuals harbored regions of underperfused, idling neurons that responded rapidly to restored cerebral reperfusion.

http://bit.ly/2WBmyJV

The patient’s perspective: follow-up Foix-Chavany-Marie syndrome secondary to bilateral traumatic operculum injury

http://bit.ly/2RyumIP

Intracranial stenting after tumor exeresis complicated by delayed kinking of the middle cerebral artery

Abstract

During intracranial tumor resection, the delayed kinking of a major encased vessel has never been described in literature. We present a case which required urgent endovascular treatment performed through a stent positioning. A patient was hospitalized with symptomatic sphenoid meningioma in the left middle cranial fossa. Twelve days after surgery, right-sided hemiplegia and aphasia occurred. Digital subtraction arteriography revealed a kinking of the M1 segment of the left middle cerebral artery and diffuse vasospasm. At first, intra-arterial nimodipine has been administered, obtaining the remission of the vasospasm. Secondly, a stent was positioned to treat the kinking, achieving a complete flow restoration.

http://bit.ly/2WDwsei

Comparison of radiological and clinical outcomes after surgical reduction with fixation or halo-vest immobilization for treating unstable atlas fractures

Abstract

Background

Unstable atlas fractures with concomitant transverse atlantal ligament (TAL) injury may be conservatively managed by halo-vest immobilization (HVI) or surgically treated by various fixation techniques. Many surgeons prefer surgical management due to complications, nonunion, and further dislocations with HVI. There are no comparative studies on surgical and nonsurgical management of unstable atlas fractures. We retrospectively assessed the radiological and clinical outcomes of surgical reduction with fixation vs. non-operative treatments for unstable atlas fractures with TAL rupture.

Methods

We analyzed records of 24 patients (15 men, 9 women; mean age, 48.3 years) with at least 1 year of follow-up. They underwent HVI or surgical reduction with fixation for unstable atlas fracture combined with TAL injury. Clinical outcomes, including neck visual analog scale and neck disability index (NDI), and radiological measurements, including degree of fracture displacement, atlantodental interval (ADI), range of motion (ROM), cervical alignment, fusion rate, and time-to-fusion, were assessed.

Results

Of the 24 patients, 13 were treated by surgical reduction with fixation (C1 lateral mass screw-C2 pedicle screw with a cross-link) and 11 by HVI. A significant reduction in lateral displacement of fractured lateral masses was identified in surgical reduction with fixation (3.21 ± 1.21 mm) compared with HVI (0.97 ± 2.69 mm). The mean reduction in ADI was 1.47 ± 1.08 mm with surgical fixation and 0.66 ± 1.02 mm with HVI. The bony rate and time-to-fusion were 100% and 14.91 ± 3.9 weeks with surgical reduction, and 72.7% and 22.31 ± 10.85 weeks with HVI. The postoperative neck pain relief and NDI after surgical fixation were higher than those after HVI.

Conclusions

Compared with HVI, surgical reduction with fixation reduces fractured lateral mass displacements, increases fusion rate, and reduces time-to-fusion while maintaining cervical curvature and improving neck pain and daily activities.

http://bit.ly/2RzTUoK

Laser-capture microdissection of murine lung for differential cellular RNA analysis

Abstract

The lung tissue contains a heterogeneous milieu of bronchioles, epithelial, airway smooth muscle (ASM), alveolar, and immune cell types. Healthy bronchiole comprises epithelial cells surrounded by ASM cells and helps in normal respiration. In contrast, airway remodeling, or plasticity, increases surrounding of bronchial epithelium during inflammation, especially in asthmatic condition. Given the profound functional difference between ASM, epithelial, and other cell types in the lung, it is imperative to separate and isolate different cell types of lungs for genomics, proteomics, and molecular analysis, which will improve the diagnostic and therapeutic approach to treat cell-specific lung disorders. Laser capture microdissection (LCM) is the technique generally used for the isolation of specific cell populations under direct visual inspection, which plays a crucial role to evaluate cell-specific effect in clinical and preclinical setup. However, maintenance of tissue RNA quality and integrity in LCM studies are very challenging tasks. It is obvious to believe that the major factor affecting the RNA quality is tissue-fixation method. The prime focus of this study was to address the RNA quality factors within the lung tissue using the different solvent system to fix tissue sample to obtain high-quality RNA. Paraformaldehyde and Carnoy's solutions were used for fixing the lung tissue and compared RNA integrity in LCM captured lung tissue samples. To further confirm the quality of RNA, we measured cellular marker genes in collected lung tissue samples from control and mixed allergen (MA)-induced asthmatic mouse model using qRT-PCR technique. RNA integrity number showed a significantly better quality of RNA in lung tissue samples fixed with Carnoy's solution compared to paraformaldehyde solution. Isolated RNA from MA-induced asthmatic murine lung epithelium, smooth muscle, and granulomatous foci using LCM showed a significant increase in remodeling gene expression compared to control which confirm the quality and integrity of isolated RNA. Overall, the study concludes tissue fixation solvent can alter the quality of RNA in the lung and the outcome of the results.

http://bit.ly/2S1XgpI

Hospital Infection Prevention: How Much Can We Prevent and How Hard Should We Try?

Abstract

Purpose of Review

To summarize the extent to which hospital-acquired infections (HAIs) are preventable and to assess expectations, challenges, and barriers to improve patient outcomes.

Recent Findings

HAIs cause significant morbidity and mortality. Getting to zero HAIs is a commonly stated goal yet leads to unrealistic expectations. The extent to which all HAIs can be prevented remains debatable and is subject to multiple considerations and barriers. Current infection prevention science is inexact and evolving. Evidence-based infection prevention practices are often incompletely implemented and at times controversial. Highly sensitive surveillance results in overdiagnosis, calling into question the real incidence of HAIs. Perceived reductions in HAIs by gaming the system lead to false conclusions about preventability and may cause harm. Successful HAI reduction programs require executive oversight yet keeping hospital leaders engaged in infection prevention is a challenge given competing priorities. Medicine is not a physical science with precisely defined laws; thus, infection prevention interventions are subject to variable outcomes.

Summary

Perhaps up to 55–70% of HAIs are potentially preventable. This is subject to a law of diminishing returns as the preventable proportion of HAIs may reduce over time with improvements in patient safety. As the principle tenet of medicine is first do no harm, infection prevention programs should relentlessly pursue reliable, sustainable, and practical strategies for heightened patient safety.

http://bit.ly/2HNDJEV

Hospital Infection Prevention: How Much Can We Prevent and How Hard Should We Try?

Abstract

Purpose of Review

To summarize the extent to which hospital-acquired infections (HAIs) are preventable and to assess expectations, challenges, and barriers to improve patient outcomes.

Recent Findings

HAIs cause significant morbidity and mortality. Getting to zero HAIs is a commonly stated goal yet leads to unrealistic expectations. The extent to which all HAIs can be prevented remains debatable and is subject to multiple considerations and barriers. Current infection prevention science is inexact and evolving. Evidence-based infection prevention practices are often incompletely implemented and at times controversial. Highly sensitive surveillance results in overdiagnosis, calling into question the real incidence of HAIs. Perceived reductions in HAIs by gaming the system lead to false conclusions about preventability and may cause harm. Successful HAI reduction programs require executive oversight yet keeping hospital leaders engaged in infection prevention is a challenge given competing priorities. Medicine is not a physical science with precisely defined laws; thus, infection prevention interventions are subject to variable outcomes.

Summary

Perhaps up to 55–70% of HAIs are potentially preventable. This is subject to a law of diminishing returns as the preventable proportion of HAIs may reduce over time with improvements in patient safety. As the principle tenet of medicine is first do no harm, infection prevention programs should relentlessly pursue reliable, sustainable, and practical strategies for heightened patient safety.

http://bit.ly/2HNDJEV

The successful uptake and sustainability of rapid infectious disease and antimicrobial resistance point-of-care testing requires a complex ‘mix-and-match’ implementation package

Abstract

The emergence and spread of antimicrobial resistance is one of the major global issues currently threatening the health and wealth of nations, with effective guidelines and intervention strategies urgently required. Such guidelines and interventions should ideally be targeted at individuals, communities, and nations, requiring international coordination for maximum effect. In this respect, the European Joint Programming Initiative on Antimicrobial Resistance Transnational Working Group 'Antimicrobial Resistance - Rapid Diagnostic Tests' (JPIAMR AMR-RDT) is proposing to consider a 'mix-and-match' package for the implementation of point-of-care testing (PoCT), which is described in this publication. The working group was established with the remit of identifying barriers and solutions to the development and implementation of rapid infectious disease PoCT for combatting the global spread of antimicrobial resistance. It constitutes a multi-sectoral collaboration between medical, technological, and industrial opinion leaders involved in in vitro diagnostics development, medical microbiology, and clinical infectious diseases. The mix-and-match implementation package is designed to encourage the implementation of rapid infectious disease and antimicrobial resistance PoCT in transnational medical environments for use in the fight against increasing antimicrobial resistance.

http://bit.ly/2UFT4ZR

Impact of type of tooth on outcome of non-surgical root canal treatment

Abstract

Objectives

We assessed the impact of type of tooth on the outcome of root canal treatment (RCT) according to factors potentially weakening the prognosis such as preoperative apical periodontitis (AP) and treatment modality (primary or secondary RCT).

Materials and methods

We scrutinized patient documents including pre- and postoperative radiographs of 640 permanent teeth receiving non-surgical RCT at Helsinki University Clinic in 2008–2011. Of teeth, 44% were molars, 32% premolars, and 24% anterior teeth. Patients' mean age was 51.5 years; 51% were male. AP was present in 60.5% of teeth preoperatively. We used the periapical index (PAI) to assess the radiographs and defined radiographically "healthy" and "healing" cases as successful. Statistical evaluation included chi-squared tests, Fisher's exact tests, t tests, and logistic regression modeling.

Results

The overall success rate (SR) was 84.1%; 88.3% for primary and 75.5% for secondary RCT (p < 0.001). The SRs for anterior teeth, premolars and molars were 85.6%, 88.8%, and 79.7%, respectively. Teeth with and without AP had SRs of 77.3% and 94.5%, respectively (p < 0.001). The RCTs were more likely to succeed in anterior teeth and premolars than in molars (OR 1.7; 95% CI 1.1–2.7) and in females than in males (OR 1.9; 95% CI 1.2–3.1).

Conclusions

Apart from existing AP and retreatment scenario, also, the type of tooth and gender had a significant influence on the outcome of RCT in this study.

Clinical relevance

The prognosis of RCT varies by type of tooth; special attention should be given to RCT of molar teeth.

http://bit.ly/2G7iFHy

Cost-utility analysis of aprepitant for patients who truly need it in Japan

Abstract

Purpose

Neurokinin-1 receptor antagonist (NK₁RA) is recommended to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly or moderately emetogenic chemotherapy (HEC or MEC, respectively). We previously reported that aprepitant, an NK₁RA, was needed to control CINV in 43% and 12% of patients who received HEC and MEC, respectively (Support Care Cancer 23:905–912, 2015). To elucidate the cost-effectiveness of aprepitant in these patients, a cost-utility analysis according to the necessity of aprepitant was performed.

Methods

A decision-analytic model was developed according to the necessity of aprepitant and CINV responses in both acute and delayed phases of chemotherapy. Probabilities of health states and medical costs were derived from the results of the abovementioned trial.

Result

In patients who received HEC and needed aprepitant, the incremental cost-effectiveness ratio (ICER) with aprepitant, relative to the regimen with no aprepitant, was 7912 US dollars (USD) per quality-adjusted life year (QALY) gained, which was far below the commonly accepted threshold of 50,000 USD/QALY. The ICER was 27,457 USD/QALY in patients who received MEC and needed aprepitant. In contrast, in patients who received HEC or MEC but did not need aprepitant, the ICER was 175,959 or 478,844 USD/QALY, respectively.

Conclusion

Regardless of whether a patient received HEC or MEC, aprepitant use was highly cost-effective for patients who truly needed it. These results warrant further research to predict the necessity of NK₁RA treatment before initiating emetogenic chemotherapies.

http://bit.ly/2HLO18z

Inhibition of Histone Methyltransferase G9a Attenuates Noise-Induced Cochlear Synaptopathy and Hearing Loss

ABSTRACT

Posttranslational modification of histones alters their interaction with DNA and nuclear proteins, influencing gene expression and cell fate. In this study, we investigated the effect of G9a (KMT1C, EHMT2), a major histone lysine methyltransferase encoded by the human EHMT2 gene and responsible for histone H3 lysine 9 dimethylation (H3K9me2) on noise-induced permanent hearing loss (NIHL) in adult CBA/J mice. The conditions of noise exposure used in this study led to losses of cochlear synapses and outer hair cells (OHCs) and permanent auditory threshold shifts. Inhibition of G9a with its specific inhibitor BIX 01294 or with siRNA significantly attenuated these pathological features. Treatment with BIX 01294 also prevented the noise-induced decrease of KCNQ4 immunolabeling in OHCs. Additionally, G9a was increased in cochlear cells, including both outer and inner sensory hair cells, some spiral ganglion neurons (SGNs), and marginal cells, 1 h after the completion of the noise exposure. Also subsequent to noise exposure, immunoreactivity for H3K9me2 appeared in some nuclei of OHCs following a high-to-low frequency gradient with more labeled OHCs in the 45-kHz than the 32-kHz region, as well as in the marginal cells and in some SGNs of the basal turn. These findings suggest that epigenetic modifications of H3K9me2 are involved in NIHL and that pharmacological targeting of G9a may offer a strategy for protection against cochlear synaptopathy and NIHL.

http://bit.ly/2WAxcRi

Withdrawal from acute medication normalises short-term cortical synaptic potentiation in medication overuse headache

Abstract

Objectives

To study the effects of a standard acute medication withdrawal program on short-term cortical plasticity mechanisms in patients with medication overuse headache (MOH).

Methods

Thirteen patients with MOH and 16 healthy volunteers underwent repetitive transcranial magnetic stimulation (rTMS) over the left motor cortex; in patients with MOH, recordings were performed before and after a 3-week medication withdrawal program. Ten trains of 10 stimuli each (120% resting motor threshold) were delivered at 1 Hz or 5 Hz in two separate sessions in a randomised order. Motor evoked potential (MEP) amplitudes were measured from the right first dorsal interosseous muscle and the slope of the linear regression line from the first to the tenth stimuli was calculated for each participant.

Results

All subjects exhibited MEP amplitude inhibition in response to 1 Hz rTMS. Alternatively, the 5-Hz trains of rTMS inhibited rather than potentiated MEP amplitudes in patients with MOH. The physiological potentiating effect of 5 Hz rTMS on MEP amplitudes was restored after drug withdrawal and in proportion with the percentage reduction in monthly headache days in patients with MOH.

Conclusions

The results suggest that acute medication withdrawal normalises brain responses in patients with MOH. Clinical improvements after medication withdrawal may reflect the reversal of neurophysiological dysfunction. Accordingly, medication withdrawal should be offered to patients with MOH as early as possible in order to prevent the development of more pronounced alterations in brain plasticity.

http://bit.ly/2t0v7jZ

Health concerns of cancer survivors after primary anti-cancer treatment

Abstract

Purpose

Cancer survivors experience significant health concerns compared to the general population. Sydney Survivorship Clinic (SSC) is a multi-disciplinary clinic aiming to help survivors treated with curative intent manage side effects, and establish a healthy lifestyle. Here, we determine the health concerns of survivors post-primary treatment.

Methods

Survivors completed questionnaires assessing symptoms, quality of life (QOL), distress, diet, and exercise before attending SSC, and a satisfaction survey after. Body mass index (BMI), clinical findings and recommendations were reviewed. Descriptive statistical methods were used.

Results

Overall, 410 new patients attended SSC between September 2013 and April 2018, with 385 survivors included in analysis: median age 57 years (range 18–86); 69% female; 43% breast, 31% colorectal and 19% haematological cancers. Median time from diagnosis, 12 months. Common symptoms of at least moderate severity: fatigue (45%), insomnia (37%), pain (34%), anxiety (31%) and with 56% having > 5 moderate-severe symptoms. Overall, 45% scored distress ≥ 4/10 and 62% were rated by clinical psychologist as having 'fear of cancer recurrence'. Compared to population mean of 50, mean global QOL T-score was 47.2, with physical and emotional well-being domains most affected. Average BMI was 28.2 kg/m² (range 17.0–59.1); 61% overweight/obese. Only 31% met aerobic exercise guidelines. Overall, 98% 'agreed'/'completely agreed' attending the SSC was worthwhile, and 99% would recommend it to others.

Conclusion

Distress, fear of cancer recurrence, fatigue, obesity and sedentary lifestyle are common in cancer survivors attending SSC and may best be addressed in a multi-disciplinary Survivorship Clinic to minimise longer-term effects. This model is well-rated by survivors.

http://bit.ly/2DOIGt2

Proposal for a simple algorithm to differentiate adult-onset Still’s disease with other fever of unknown origin causes: a longitudinal prospective study

Abstract

Objective

To identify several clinical and/or laboratory parameters which can differentiate adult-onset Still's disease (AOSD) from other causes of fever of unknown origin (FUO) and create a clinician-friendly algorithm for this purpose.

Methods

FUO patients hospitalized between March 2015 and September 2017 were recruited prospectively. AOSD patients diagnosed between 2001 and 2017 in our department were analyzed. Clinical and laboratory parameters were recorded for all patients. A multivariate analysis was performed to identify possible parameters related to the discrimination of AOSD from FUO.

Results

We recruited 69 AOSD patients (51 females, 74%) and 87 patients (43 females, 49.4%) evaluated for FUO. Median ages were 45 (30–57) and 45 (30–62), respectively. Arthralgia, rash, sore throat, neutrophilia, serum ferritin level higher than 5 times of the upper limit, and elevated lactate dehydrogenase levels were associated with the likelihood of diagnosing AOSD; on the other hand, the number of daily fever peaks equal or greater than 3 was associated with the unlikelihood of diagnosing AOSD. After the clinical feasibility assessment of possible parameters derived from the multivariate analysis, in the setting of fever, two clinical (arthralgia, sore throat) and two laboratory (ferritin level, neutrophilia) parameters were selected to develop an algorithm for discrimination of AOSD and FUO.

Conclusion

Presence of arthralgia, hyperferritinemia, sore throat, and neutrophilia suggests AOSD in patients presenting as FUO. This study proposes a clinician-friendly algorithm for the first time in current literature to discriminate AOSD from other causes of FUO.

http://bit.ly/2SjLuWX

A Tunable Resonance Cantilever for Cardiac Energy Harvesting

Abstract

Purpose

Energy harvesting from cardiac motion is an attractive means to avoid the use of batteries in implantable sensors and pacemakers. A single implantable device would ideally integrate both sensing and self-powering functionality.

Methods

This work describes a novel electromagnetic system that achieves high sensitivity detection of the heart rate while simultaneously providing adaptive energy harvesting capability using a tunable resonance cantilever mechanism.

Results

Our prototype design exhibits tunability of resonant frequency across the range of physiologic heart rates at a combination of lengths and angular orientations. Our initial prototype also produces between 3.0  \(\mu\) W and 20.6  \(\mu\) W of power at heart rates of 79–243 bpm, respectively.

Conclusions

The prototype device can harvest sufficient energy to sustain implantable cardiac devices such as a leadless pacemaker. The system in this paper has the potential to eliminate batteries in certain implantable cardiac devices and thereby improve overall patient monitoring and treatment.

http://bit.ly/2WAl8Q0

Spatiotemporal Complexity of the Aortic Sinus Vortex as a Function of Leaflet Calcification

Abstract

Several studies have shown the variation of aortic sinus structures' hemodynamics with different flow and geometric characteristics. They have also correlated aortic sinus hemodynamics with the progression and evolution of calcific aortic valve disease (CAVD). This study aims at visualizing aortic sinus fluid structure variations as functions of different leaflet calcification degrees and assessing their potential relationship with CAVD. A degenerated 23 mm Carpentier-Edwards Perimount Magna valve extracted from a redo-surgery patient was implanted in an aortic root model and tested in a pulse duplicator left heart simulator. The valve has 3 leaflets with 3 different levels of calcium distribution: mild, moderate and severe. High-speed imaging and particle image velocimetry were performed to assess sinus vortices, leaflet tip position and velocity along with shear stress. Results have shown that (a) aortic sinus vortices initiation, entrapment and evolution varied with different calcified leaflet exposure; (b) higher velocities in the sinus were calculated with the mildly calcified leaflet compared to the moderately and severely calcified ones; (c) during systole, the mildly calcified leaflet sinus case shows the most spread-out and higher ranges of shear stress probabilities and highest magnitudes going from (− 1.5 to + 1.8 Pa) compared with (− 1.0 to + 1.0 Pa) for moderately and severely calcified leaflets. The higher the calcification degree the lower the shear stress range and likelihoods of having higher shear stress. This holds in diastole as well. This study shows the impact of calcification on the aortic sinus flow structures.

http://bit.ly/2sZ7Mz5

Pore-Scale Level Set Simulations of Capillary-Controlled Displacement with Adaptive Mesh Refinement

Abstract

Multiphase flow simulations on imaged porous rock structures require numerical methods that are accurate and robust when applied on complex geometries. A key element in this context is to investigate how simulations behave under grid refinement. In this work, we couple an existing software for structured adaptive mesh refinement (AMR) and parallelism to a previously developed level set method for capillary-controlled displacement on the pore scale. The level set method accounts for wettability by using different evolution velocities in pore and solid space rather than implementing it as a boundary condition on the pore walls. We perform simulations with up to three nested refinement levels on idealized pore geometries to validate the AMR technology. Based on simulations, we identify suitable cell refinement criteria for our applications. We demonstrate effects of AMR in simulations relevant for drainage in porous media, such as in the computation of capillary entry pressures in pore throats with different shapes and wetting states, and obtain excellent agreement with analytic results. Finally, we investigate the effects of AMR during simulation of quasi-static drainage on sandstone. The comparison of capillary equilibrium fluid configurations, capillary pressure, and specific fluid/fluid interfacial area–saturation relationships for drainage with and without AMR shows differences that diminish for less water-wet states. The general behavior is that the capillary pressure and interfacial area for a given saturation increase in simulations with AMR. The largest deviation occurs for small water saturations, suggesting AMR can be an important component in simulation tools to describe more accurately capillary behavior in the low water saturation regime where interface curvature is high.

http://bit.ly/2TsGXig

4-Methyl-5-Pentylbenzene-1,3-Diol Regulates Chemotactic Cell Aggregation and Spore Maturation Via Different Mechanisms in Dictyostelium discoideum

Abstract

4-Methyl-5-pentylbenzene-1,3-diol (MPBD), a product of the polyketide synthase SteelyA, is a signaling molecule that regulates Dictyostelium discoideum development. During early development, MPBD controls chemotactic cell aggregation by regulating the expression of genes in the cAMP signaling pathway; however, during culmination at late development, it induces spore maturation. In the present study, we analyzed the effects of MPBD, its derivatives, and a putative MPBD-derived metabolite on developmental defects in the MPBD-less stlA null mutant. Using structure–activity relationship studies, it was observed that in MPBD, the functional groups that were essential for induction of spore maturation were different from those essential for induction of cell aggregation. Dictyoquinone, a putative MPBD metabolite rescued the aggregation defect in stlA null mutant in early development, but not the spore maturation defect at the later stage. Our data suggest that MPBD regulates chemotactic cell aggregation and spore maturation via different mechanisms.

http://bit.ly/2Bg1Zd3

Tailoring the performance of bamboo filler reinforced epoxy composite: insights into fracture properties and fracture mechanism

Abstract

Due to the graded micro-structure and high specific strength-stiffness, bamboo micro fillers are systematically utilized in reinforcing different thermoset and thermoplastic polymers as replacement of conventional glass and carbon fillers. In this work, micro-size bamboo particle fillers are reinforced in 'specific grade' thermoset epoxy matrix and its fracture properties has been evaluated by following linear elastic fracture mechanics. To enhance its compatibility with the polymer matrix and to reduce the hydrophilicity, the bamboo micro fillers are surface modified through alkaline treatment. The extent of surface modification and removal of lower weight polymers from filler surface are examined and established by Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction analysis and thermogravimetric analysis. The fracture properties of bamboo-epoxy composite material are observed to be increasing with the addition of bamboo fillers and the maximum value of fracture toughness is 0.678 MPa.m^0.5 which is 32% higher than the same for neat epoxy samples. In addition, the mechanisms of notch initiated fracture propagation have also been explained for the understanding of stress singularity present at the preexisted crack tip.

http://bit.ly/2HLfXJJ

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

Abstract

Objective

Near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) might help reduce anastomotic leakage (AL) after colorectal surgery. This pilot study aims to analyze whether a relation exists between measured fluorescence intensity (FI) and postoperative inflammatory markers of AL, C-reactive protein (CRP), Intestinal fatty-acid binding protein (I-FABP), and calprotectin, to AL, in order to evaluate the potential of FI to objectively predict AL.

Methods

Patients scheduled for anastomotic colorectal cancer surgery were eligible for inclusion in this prospective pilot study. During surgery, at three time points (after bowel devascularization; before actual transection; after completion of anastomosis) a bolus of 0.2 mg/kg ICG was administered intravenously for assessment of bowel perfusion. FI was scored in scale from 1 to 5 based on the operating surgeon's judgment (1 = no fluorescence visible, 5 = maximum fluorescent signal). The complete surgical procedure was digitally recorded. These recordings were used to measure FI postoperatively using OsiriX imaging software. Serum CRP, I-FABP, and calprotectin values were determined before surgery and on day 1, 3, and 5 postoperative; furthermore, the occurrence of AL was recorded.

Results

Thirty patients (n = 19 males; mean age 67 years; mean BMI 27.2) undergoing either laparoscopic or robotic anastomotic colorectal surgery were included. Indication for surgery was rectal—(n = 10), rectosigmoid—(n = 2), sigmoid—(n = 10), or more proximal colon carcinomas (n = 8). Five patients (16.7%) developed AL (n = 2 (6.6%) grade C according to the definition of the International Study group of Rectal Cancer). In patients with AL, the maximum fluorescence score was given less often (P = 0.02) and a lower FI compared to background FI was measured at 1st assessment (P = 0.039). However, no relation between FI and postoperative inflammatory parameters could be found.

Conclusion

Both subjective and measured FI seem to be related to AL. In this study, no relation between FI and inflammatory serum markers could yet be found.

http://bit.ly/2SiaZrY

Three-dimensional versus two-dimensional high-definition laparoscopy in cholecystectomy: a prospective randomized controlled study

Abstract

Background

While 3D laparoscopy increases surgical performance under laboratory conditions, it is unclear whether it improves outcomes in real clinical scenarios. The aim of this trial was to determine whether the 3D laparoscopy can enhance surgical efficacy in laparoscopic cholecystectomy (LCC).

Method

This prospective randomized controlled study was conducted between February 2015 and April 2017 in a day case unit of an academic teaching hospital. Patients scheduled for elective LCC were assessed for eligibility. The exclusion criteria were: (1) planned secondary operation in addition to LCC, (2) predicted to be high-risk for conversion, and (3) surgeons with less than five previous 3D laparoscopic procedures. Patients were operated on by 12 residents and 3 attendings. The primary endpoint was operation time. All surgeons were tested for stereoaquity (Randot® stereotest). The study was registered in ClinicalTrials.gov (NCT02357589).

Results

A total of 210 patients were randomized; 105 to 3D laparoscopy and 104 to 2D laparoscopy. Median operation time as similar in the 3D and 2D laparoscopy groups (49 min vs. 48 min, p = 0.703). Operation times were similar in subgroup analyses for surgeon's sex (male vs. female), surgeon's status (resident vs. attending), surgeon's stereovision (stereopsis 10 vs. less than 10), surgeon's experience (performed 200 LCCs or below versus over 200 LCCs), or patient's BMI (≤ 25 vs. 25–30 vs. > 30). No differences in intra- or postoperative complications were noted between the 3D and 2D groups.

Conclusion

3D laparoscopy did not show any advantages over 2D laparoscopy in LCC.

http://bit.ly/2GiO0GD

Did a training seminar really reduce endotracheal cuff pressure?

http://bit.ly/2SfyGRF

Implementing Evidence Based Practices for Children’s Mental Health: A Case Study in Implementing Modular Treatments in Community Mental Health

Abstract

There is strong enthusiasm for utilizing implementation science in the implementation of evidence-based programs in children's community mental health, but there remains work to be done to improve the process. Despite the proliferation of implementation frameworks, there is limited literature providing case examples of overcoming implementation barriers. This article examines whether the use of three implementations strategies, a structured training and coaching program, the use of professional development portfolios for coaching, and a progress monitoring data system, help to overcome barriers to implementation by facilitating four implementation drivers at a community mental health agency. Results suggest that implementation is a process of recognizing and adapting to both predictable and unpredictable barriers. Furthermore, the use of these implementation strategies is important in improving implementation outcomes.

http://bit.ly/2HLxzVO

On the Inertial Single Phase Flow in 2D Model Porous Media: Role of Microscopic Structural Disorder

Abstract

In this work, single-phase incompressible laminar flow in 2D model porous media is studied and the influence of microscopic structural disorder on the flow is thoroughly investigated. Emphasis is laid upon the onset of the deviation from Darcy's law and the identification of different inertia regimes observed before the flow becomes unsteady. For this purpose, six globally disordered pore structures were generated and the values of the critical Reynolds number at which the flow becomes unsteady corresponding to the first Hopf bifurcation were determined. Numerical simulations of steady laminar single-phase flow were then carried out to investigate the effects of the microstructures on the inertial correction to Darcy's law. Different flow regimes, namely weak inertia, strong inertia and the regime beyond strong inertia, are identified. Comparisons are made with results presented in the literature which were restricted to ordered and locally disordered structures. The critical Reynolds number decreases and inertia intensity increases as more disorder is introduced into the pore structure. Results on flow inertia widely extend some previous studies on the subject and show that it is mainly influenced by the shape of the obstacles (either circular or square), slightly affected by the inclination of the square cylinders and hardly disturbed by the size distribution of the obstacles.

http://bit.ly/2Ggy33M

Message from the Editor-in-Chief

http://bit.ly/2Ru55zf

Genome Analysis of Carbaryl-Degrading Strain Pseudomonas putida XWY-1

Abstract

Carbaryl was a widely used pesticide in the agriculture industry. The toxicity against non-target organisms and the environmental pollution it caused became the focus of public concern. However, the microbial mechanism of carbaryl degradation was not fully investigated. In the study, we reported the complete genome of the carbaryl-degrading Pseudomonas putida strain XWY-1, which consists of a chromosome (5.9 Mbp) and a plasmid (0.4 Mbp). The carbaryl degradation genes are located on the plasmid. The study on the genome will facilitate to further elucidate the carbaryl degradation and advance the potential biotechnological applications of P. putida strain XWY-1.

http://bit.ly/2TlJhrr

Evaluating Formal Models of Science

Abstract

This paper presents an account of how to evaluate formal models of science: models and simulations in social epistemology designed to draw normative conclusions about the social structure of scientific research. I argue that such models should be evaluated according to their representational and predictive accuracy. Using these criteria and comparisons with familiar models from science, I argue that most formal models of science are incapable of supporting normative conclusions.

http://bit.ly/2sZx2Fn

Mechanisms, Models and Laws in Understanding Supernovae

Abstract

There has been a burst of work in the last couple of decades on mechanistic explanation, as an alternative to the traditional covering-law model of scientific explanation. That work makes some interesting claims about mechanistic explanations rendering phenomena 'intelligible', but does not develop this idea in great depth. There has also been a growth of interest in giving an account of scientific understanding, as a complement to an account of explanation, specifically addressing a three-place relationship between explanation, world, and the scientific community. The aim of this paper is to use the contextual theory of scientific understanding to build an account of understanding phenomena using mechanistic explanations. This account will be developed and illustrated by examining the mechanisms of supernovae, which will allow synthesis of treatment of the life sciences and social sciences on the one hand, where many accounts of mechanisms were originally developed, and treatment of physics on the other hand, where the contextual theory drew its original inspiration.

http://bit.ly/2HKjsjt

Driving Policy Change to Improve Micronutrient Status in Women of Reproductive Age and Children in Southeast Asia: The SMILING Project

Abstract

Objective The SMILING (Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional Status and General Health in Asia) project aimed at creating awareness and improving policies around micronutrient deficiencies in five Southeast Asian countries (Vietnam, Laos, Thailand, Cambodia and Indonesia). Results The project showed large gaps in recent data on micronutrient status in most of the five countries. By updating existing, or creating national food composition tables, the SMILING project enabled analyses of food consumption in women of reproductive age and young children. Linear programming showed a high risk for multiple micronutrient deficiencies in these groups, and especially in pregnant women. Most programs to improve micronutrient status target iodine, iron and vitamin A deficiency. However, the high prevalence of zinc, vitamin D, thiamine and folate deficiency in the region warrant interventions too. For certain micronutrients (zinc, iron, calcium), dietary changes alone appeared not enough to fulfill requirements. Food fortification was identified to be a sustainable, long-term solution to improve micronutrient intake. Multiple criteria mapping by stakeholders in each country resulted in a list of country-specific priority interventions. Surprisingly, food fortification was ranked low, due to concerns on quality control and organoleptic changes of the fortified food. More advocacy is needed for new, innovative interventions such as delayed cord clamping. Conclusions for practice The SMILING project recommends regular surveys to monitor micronutrient status of population, to measure impact of interventions and to guide nutrition policies.

http://bit.ly/2HLJL97

Evaluating the Whoops Proof S.C . Campaign: A Pair-Matched Group Pretest–Posttest Quasi-experimental Study

Abstract

Introduction: In South Carolina, 50% of all pregnancies are unintended. Intrauterine devices (IUDs) and the implant are recommended as top-tier contraceptive options for all women and adolescents. The Whoops Proof S.C. campaign was evaluated to determine if women (ages 18 to 29) who do not intend to become pregnant in the next year report greater awareness of and positive regard for IUDs and the implant after exposure to a multi-channel campaign. Methods: A pair-matched group pretest–posttest quasi-experimental design was utilized. A total of 1,439 women responded to the pretest survey (May–July 2016) and 1,534 responded to the posttest survey (October–November 2016) in four South Carolina counties. Statistical analysis include paired-sample and independent t-tests and one-way ANOVA tests for variance. Results: At posttest, intervention county participants were significantly more likely to recall messaging and to report receiving contraceptive information from Whoops Proof S.C (t(1533)= − 8.466, p < .0001). Participants who saw ads more than once per week reported a significant increase in awareness of IUDs and the implant (F(6,1532) = 5.571; p < .001). Participants in intervention counties reported a significant increase in positive attitudes toward IUDs (t(616) = − 1.740; p = .041) and the implant (t(603)= − 1.665; p = .048). Discussion: The Whoops Proof S.C. campaign offers strategies to campaign planners and health care providers to optimize exposure and recall frequency to increase awareness of and positive regard for highly effective contraceptive methods. Campaign planners should test messages and focus on communication channels to increase engagement and avoid saturation.

http://bit.ly/2sZqnuR

Driving Policy Change to Improve Micronutrient Status in Women of Reproductive Age and Children in Southeast Asia: The SMILING Project

Abstract

Objective The SMILING (Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional Status and General Health in Asia) project aimed at creating awareness and improving policies around micronutrient deficiencies in five Southeast Asian countries (Vietnam, Laos, Thailand, Cambodia and Indonesia). Results The project showed large gaps in recent data on micronutrient status in most of the five countries. By updating existing, or creating national food composition tables, the SMILING project enabled analyses of food consumption in women of reproductive age and young children. Linear programming showed a high risk for multiple micronutrient deficiencies in these groups, and especially in pregnant women. Most programs to improve micronutrient status target iodine, iron and vitamin A deficiency. However, the high prevalence of zinc, vitamin D, thiamine and folate deficiency in the region warrant interventions too. For certain micronutrients (zinc, iron, calcium), dietary changes alone appeared not enough to fulfill requirements. Food fortification was identified to be a sustainable, long-term solution to improve micronutrient intake. Multiple criteria mapping by stakeholders in each country resulted in a list of country-specific priority interventions. Surprisingly, food fortification was ranked low, due to concerns on quality control and organoleptic changes of the fortified food. More advocacy is needed for new, innovative interventions such as delayed cord clamping. Conclusions for practice The SMILING project recommends regular surveys to monitor micronutrient status of population, to measure impact of interventions and to guide nutrition policies.

http://bit.ly/2HLJL97

Evaluating the Whoops Proof S.C . Campaign: A Pair-Matched Group Pretest–Posttest Quasi-experimental Study

Abstract

Introduction: In South Carolina, 50% of all pregnancies are unintended. Intrauterine devices (IUDs) and the implant are recommended as top-tier contraceptive options for all women and adolescents. The Whoops Proof S.C. campaign was evaluated to determine if women (ages 18 to 29) who do not intend to become pregnant in the next year report greater awareness of and positive regard for IUDs and the implant after exposure to a multi-channel campaign. Methods: A pair-matched group pretest–posttest quasi-experimental design was utilized. A total of 1,439 women responded to the pretest survey (May–July 2016) and 1,534 responded to the posttest survey (October–November 2016) in four South Carolina counties. Statistical analysis include paired-sample and independent t-tests and one-way ANOVA tests for variance. Results: At posttest, intervention county participants were significantly more likely to recall messaging and to report receiving contraceptive information from Whoops Proof S.C (t(1533)= − 8.466, p < .0001). Participants who saw ads more than once per week reported a significant increase in awareness of IUDs and the implant (F(6,1532) = 5.571; p < .001). Participants in intervention counties reported a significant increase in positive attitudes toward IUDs (t(616) = − 1.740; p = .041) and the implant (t(603)= − 1.665; p = .048). Discussion: The Whoops Proof S.C. campaign offers strategies to campaign planners and health care providers to optimize exposure and recall frequency to increase awareness of and positive regard for highly effective contraceptive methods. Campaign planners should test messages and focus on communication channels to increase engagement and avoid saturation.

http://bit.ly/2sZqnuR

Reply to: “Diagnostic test accuracy of the Montreal Cognitive Assessment in the detection of post-stroke cognitive impairment under different stages and cutoffs: a systematic review and meta-analysis”

http://bit.ly/2UyQ7Ke

😴😴😴Sleep Medicine🕵🕵️‍♀️

16:51

  Characterizing Pediatric Inpatient Sleep Duration and Disruptions

via Sleep Medicine

Publication date: Available online 31 January 2019

Source: Sleep Medicine

Author(s): Amarachi I. Erondu, Nicola M. Orlov, Leah B. Peirce, Samantha L. Anderson, Michael Chamberlain, Kelsey Hopkins, Christopher Lyttle, David Gozal, Vineet M. Arora

Abstract

Objective

To contextualize inpatient sleep duration and disruptions in a general pediatric hospital ward by comparing in-hospital and at-home sleep durations to recommended guidelines and objectively measure nighttime room entries.

Methods

Caregivers of patients 4 weeks - 18 years of age reported patient sleep duration and disruptions in anonymous surveys. Average at-home and in-hospital sleep durations were compared to National Sleep Foundation recommendations. Objective nighttime traffic was evaluated as the average number of room entries between 11:00pm and 7:00am using GOJO hand-hygiene room entry data.

Results

Among 246 patients, patients slept less in the hospital than at home with newborn and infant cohorts experiencing 7- and 4-hour sleep deficits respectively (Newborn: 787 ± 318 min at home vs. 354 ± 211 min in hospital, p<0.001; Infants: 530 ± 115 min at home vs. 412 ± 152 min in hospital, p<0.01). Newborn children also experienced >2 hour sleep deficits at home when compared to NSF recommendations (Newborns: 787 ± 318 min at home vs. 930 min recommended, p< 0.05). Objective nighttime traffic measures revealed that hospitalized children experienced 10 room entries/night (10 ± 5.9 entries). Nighttime traffic was significantly correlated with caregiver-reported nighttime awakenings (Spearman Rank Correlation Coefficient: 0.58, p=.04).

Conclusion

Hospitalization is a missed opportunity to improve sleep both in the hospital and at home.

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16:51

  Insomnia Treatment Response as a Function of Objectively Measured Sleep Duration

via Sleep Medicine

Publication date: Available online 31 January 2019

Source: Sleep Medicine

Author(s): Amélie Rochefort, Denise C. Jarrin, Lynda Bélanger, Hans Ivers, Charles M. Morin

Abstract

Objectives

To examine the potential moderating effect of objectively measured sleep duration at baseline on the response to cognitive behavioral therapy for insomnia (CBT-I), administered singly or combined with medication (CBT-I+Med).

Methods

Based on the average PSG-derived sleep duration across two baseline nights and the type of treatment received, 159 adults with insomnia (50.3 ± 10.1 years; 61.0% women) were classified into one of four groups: participants with short sleep duration (i.e., ≤ 6h) treated with CBT-I (n = 26) or CBT-I+Med (n = 25), and participants with normal sleep duration (i.e., > 6h) treated with CBT-I (n = 54) or CBT-I+Med (n = 54). Primary outcome measures were sleep/wake parameters derived from a sleep diary and insomnia severity and secondary outcomes were beliefs about sleep, fatigue, depression and anxiety.

Results

Patients with both short and normal sleep durations at baseline improved significantly on most sleep continuity parameters with CBT-I administered singly or combined with medication. Irrespective of treatment received, participants with short sleep duration also showed significantly greater improvements in subjective sleep (i.e., reduced wake after sleep onset, increased sleep efficiency) relative to those with normal sleep duration. Conversely, participants with normal sleep duration showed greater improvements on some measures of daytime functioning and sleep satisfaction.

Conclusions

There was no moderating effect of baseline sleep duration on treatment response to cognitive behavioral therapy. Despite some marginal differential treatment response on selected daytime functioning outcomes, the benefits from CBT-I were not significantly different as a function of short or normal sleep duration at baseline. Further prospective investigation of insomnia phenotypes taking into account other variables than sleep duration is warranted in order to develop more targeted insomnia therapies.

Trial registration

www.clinicaltrials.gov (#NCT 00042146)

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Thu Jan 31, 2019 12:40

  Association of change in physical activity and sleep complaints: Results from a 6-year longitudinal study with Swedish health care workers

via Sleep Medicine

Publication date: Available online 31 January 2019

Source: Sleep Medicine

Author(s): Markus Gerber, Mats Börjesson, Ingibjörg H. Jonsdottir, Magnus Lindwall

Abstract

Objective

To increase our understanding of patterns of change in physical activity and sleep complaints and to test whether intra-individual changes in physical activity are correlated with intra-individual changes in sleep complaints across four measurement time-points over six years, adopting both a between-person and within-person perspective.

Methods

Data from a longitudinal cohort study were used in this research. At baseline, 3187 participants took part in the study (86% women, Mage=46.9 years). The response rate was 84% (n=3136) after two years, 60% (n=2232) after four years, and 40% (n=1498) after six years. Physical activity was assessed with the [51] widely used 4-level physical activity scale (SGPALS), and sleep complaints, with three items from the Karolinska Sleep Questionnaire (KSQ). Patterns and correlations of change between physical activity and sleep complaints were examined with latent growth curve modeling.

Results

Changes in physical activity were associated with changes in sleep complaints across the six years. More specifically, significant associations occurred between baseline levels, correlated (between-person) change, and coupled (within-person change). These associations indicate that higher physical activity levels are not only cross-sectionally linked with fewer sleep complaints, but that increases in physical activity over time (either in comparison to others or to oneself) are paralleled by decreases in sleep complaints.

Conclusions

Given that changes in physical activity and sleep are correlated, our findings indicate that it is both worthwhile to initiate more physically active lifestyles in physically inactive individuals and to ensure that those who are already physically active maintain their physical activity levels over longer periods.

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  Continuous positive airway pressure alters brain microstructure and perfusion patterns in patients with obstructive sleep apnea

via Sleep Medicine

Publication date: Available online 31 January 2019

Source: Sleep Medicine

Author(s): Hillel S. Maresky, Isaac Shpirer, Miriam M. Klar, Max Levitt, Efrat Sasson, Sigal Tal

Abstract

Objectives

To assess the effects of continuous positive airway pressure (CPAP) treatment on brain structure and function in patients with obstructive sleep apnea (OSA).

Methods

A prospective study of seven OSA patients recruited from the sleep center at our institution was carried out. Patients were treated with 6 weeks of CPAP treatment. Pre-treatment and post-treatment magnetic resonance imaging (MRI) perfusion scans were obtained and compared to assess for treatment-induced changes. Microstructural changes were quantified using functional anistrophy (FA) and mean diffusivity (MD), and brain perfusion was quantified using cerebral blood flow (CBF) and cerebral blood volume (CBV).

Results

Of the seven patients included the in study, six (85.7%) were male, and the mean age of the study population was 51 years (standard deviation = 13.14). Increased FA and decreased MD were found in the hippocampus, temporal lobes, fusiform gyrus, and occipital lobes. Decreased FA and increased MD were found in frontal regions for all patients (p<0.05). Increased CBF and CBV were also observed following treatment (p<0.05).

Conclusion

In addition to symptom resolution, CPAP treatment may allow for healing of OSA-induced brain damage as seen by restoration of brain structure and perfusion.

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Thu Jan 31, 2019 12:40

  Postpartum fatigue, daytime sleepiness, and psychomotor vigilance are modifiable through a brief residential early parenting program

via Sleep Medicine

Publication date: Available online 31 January 2019

Source: Sleep Medicine

Author(s): Nathan Wilson, Karen Wynter, Clare Anderson, Shantha.M.W. Rajaratnam, Jane Fisher, Bei Bei

Abstract

Objective

/Background: In the months after childbirth, women are vulnerable to sleep disturbances and sleep-related deficits in functioning, such as fatigue, daytime sleepiness, and attentional lapses. Currently there is limited evidence that these deficits are modifiable. Using both self-report and objective measures, this study examined changes in sleep-related daytime functioning among women attending a residential early parenting program for assistance with unsettled infant behavior and mild to moderate postpartum distress.

Methods

Participants were 78 women (age M=34.16, SD=4.16 years) attending a 5-day program with their infants (age M=8.67, SD=4.82 months). Sleep was assessed via self-report. Sleep-related daytime functioning was operationalized as fatigue, sleepiness, and sustained attention, and measured using validated questionnaires (all women) and the 10-min visual Psychomotor Vigilance Test (PVT; subgroup of 47 women). All measures were administered on both admission (baseline) and discharge.

Results

On admission, participants reported elevated sleep disturbance (94%), fatigue (91%), as well as trait (54%) and state (67%) sleepiness. From admission to discharge, there were medium effect size reductions in fatigue and sleepiness, and large effect size improvements in sleep quality related domains such as increased sleep efficiency and reduced nighttime awakenings (all p<.001); changes in total sleep time were nonsignificant (p=.22). PVT reciprocal mean reaction times were also significantly faster (p=.001; medium effect size).

Conclusions

This study demonstrated that among women attending a brief residential early parenting program, fatigue, daytime sleepiness, and objectively measured psychomotor vigilance can be improved. Implications for further research and potential treatments are discussed.

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Thu Jan 31, 2019 12:40

  Poor sleep quality and lipid profile in a rural cohort (The Baependi Heart Study)

via Sleep Medicine

Publication date: Available online 30 January 2019

Source: Sleep Medicine

Author(s): Glaucylara Reis Geovanini, Geraldo Lorenzi-Filho, Lilian K. de Paula, Camila Maciel Oliveira, Rafael de Oliveira Alvim, Felipe Beijamini, André Brooking Negrão, Malcolm von Schantz, Kristen L. Knutson, José Eduardo Krieger, Alexandre Costa Pereira

Abstract

Aim

To test the association between cardiometabolic risk factors and subjective sleep quality assessed by the Pittsburgh sleep quality index (PSQI), independent of obstructive sleep apnea (OSA) and sleep duration.

Methods

A total of 573 participants from the Baependi Heart Study, a rural cohort from Brazil, completed sleep questionnaires and underwent polygraphy for OSA evaluation. Multivariable linear regression analysis tested the association between cardiovascular risk factors (outcome variables) and sleep quality measured by PSQI, adjusting for OSA and other potential confounders (age, sex, race, salary/wage, education, marital status, alcohol intake, obesity, smoking, hypertension, and sleep duration).

Results

The sample mean age was 43±16 years, 66% were female, and mean body mass index (BMI) was 26±5 kg/m2. Only 20% were classified as obese (BMI ≥30). Fifty per cent of participants reported poor sleep quality as defined by a PSQI score ≥5. A high PSQI score was significantly associated with higher very-low-density lipoprotein (VLDL) cholesterol levels (beta=0.392, p=0.012) and higher triglyceride levels (beta=0.017, p=0.006), even after adjustments, including the apnea–hypopnea index. Further adjustments accounting for marital status, alcohol intake, and medication use did not change these findings. No significant association was observed between PSQI scores and glucose or blood pressure. According to PSQI components, sleep disturbances (beta=1.976, p=0.027), sleep medication use (beta=1.121, p=0.019), and daytime dysfunction (beta=1.290, p=0.024) were significantly associated with higher VLDL serum levels. Only the daytime dysfunction domain of the PSQI components was significantly associated with higher triglyceride levels (beta=0.066, p=0.004).

Conclusion

Poorer lipid profile was independently associated with poor sleep quality, assessed by the PSQI questionnaire, regardless of a normal sleep duration and accounting for OSA and socio-economic status.

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Thu Jan 31, 2019 12:40

  The journal on a new trajectory

via Sleep Medicine

Publication date: January 2019

Source: Sleep Medicine, Volume 53

Author(s): Sudhansu Chokroverty

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🤓🧘 Dangerous non-food products🧛‍♂️🤦🤦‍♀️

Serious risk 

1 of 3 photos PreviousNext Share on             Alert number: A12/0189/19        Category:  Hobby/sports equipment   Product:  Self-balancing scooter (hoverboard)   Brand: GOCLEVER   Name: City Board SUV - Hoverboard   Type / number of model:  CBLSSBEU Black with LG battery   Batch number / Barcode:  5906736072463   Risk type:  Burns, Fire   The hoverboard's charging circuit has no cut-off switch. The battery can consequently overcharge and overheat which could lead to a fire. In addition, the plastic housing of the hoverboard can easily catch fire. The product does not comply with the requirements of the Machinery Directive and the relevant European Standards EN 60335-1 and EN 62133-2.   Measures ordered by public authorities (to: Other): Withdrawal of the product from the market

1 of 2 photos PreviousNext Share on             Alert number: A12/0190/19        Category:  Hobby/sports equipment   Product:  Self-balancing scooter/Hoverboard   Brand: Denver   Name: Balance scooter   Type / number of model:  Scooter: DBO-6501 WHITE MK2 Power charger: JY-420150   Batch number / Barcode:  5706751035494   Risk type:  Burns, Fire   The charging circuit of the product has no cut-off switch. The battery can consequently overcharge and overheat which may lead to a fire. Furthermore, the plastic housing of the hoverboard can easily catch fire.  The product does not comply with the requirements of the Machinery Directive and the relevant European Standard EN 60335-1.   Measures ordered by public authorities (to: Other): Warning consumers of the risks, Withdrawal of the product from the market

1 of 1 photo Share on             Alert number: A12/0172/19        Category:  Chemical products   Product:  Tattoo ink   Brand: Eternal Ink   Name: ROSA - HOT PINK   Type / number of model:  Unknown   Batch number / Barcode:  Batch number 02/09/16   Risk type:  Chemical   The product contains the aromatic amine o-anisidine (measured value: 26 mg/kg). This aromatic amine can cause cancer, cell mutations and affect reproduction.  The Council of Europe Resolution ResAP (2008)1 on requirements and criteria for the safety of tattoos and permanent make-up, recommends that aromatic amines with carcinogenic mutagenic, reprotoxic or sensitising properties should neither be present in tattoos and permanent make-up products nor released from azo-colourants.   Measures ordered by public authorities (to: Distributor): Ban on the marketing of the product and any accompanying measures

1 of 2 photos PreviousNext Share on             Alert number: A12/0174/19        Category:  Chemical products   Product:  Tattoo ink   Brand: Eternal Ink   Name: CARAMEL   Type / number of model:  Unknown   Batch number / Barcode:  batch R-136, expiry date 06/2020   Risk type:  Chemical   The product contains the aromatic amines o-anisidine (measured value 74 mg/kg) and o-toluidine (measured value 67 mg/kg). Aromatic amines can cause cancer, cell mutations and affect reproduction.  The Council of Europe Resolution ResAP (2008)1 on requirements and criteria for the safety of tattoos and permanent make-up, recommends that aromatic amines with carcinogenic, mutagenic, reprotoxic or sensitising properties should neither be present in tattoos and permanent make-up products nor released from azo-colourants.   Measures ordered by public authorities (to: Distributor): Ban on the marketing of the product and any accompanying measures

1 of 1 photo Share on             Alert number: A12/0179/19        Category:  Lighters   Product:  Novelty lighter   Brand: Unknown   Name: Butane gas lighters - coke bottle   Type / number of model:  Unknown   Batch number / Barcode: Unknown THE PRODUCT IS COUNTERFEIT   Risk type:  Burns, Fire   The lighter is appealing to children due to its shape and colour. Children may play with it and suffer burns or cause a fire.  The product does not comply with the relevant European standard EN 13869.   Measures taken by economic operators: Recall of the product from end users, Warning consumers of the risks, Withdrawal of the product from the market (By: Other)

1 of 1 photo Share on             Alert number: A12/0180/19        Category:  Lighters   Product:  Novelty lighter   Brand: Unknown   Name: Refillable butane gas lighter in the form of a lip   Type / number of model:  Unknown   Batch number / Barcode: Unknown   Risk type:  Burns, Fire   The lighter is appealing to children. due to its shape and colour. Children may play with it and suffer burns or cause a fire.  The product does not comply with the relevant European standard EN 13869.   Measures taken by economic operators: Recall of the product from end users, Warning consumers of the risks, Withdrawal of the product from the market (By: Other)

1 of 1 photo Share on             Alert number: A12/0181/19        Category:  Lighters   Product:  Novelty lighter   Brand: Unknown   Name: Accessories - butane gas lighter-fire-extinguisher   Type / number of model:  Unknown   Batch number / Barcode: Unknown   Risk type:  Burns, Fire   The lighter is appealing to children due to its shape and colour. Children may play with it and suffer burns or cause a fire.  The product does not comply with the relevant European standard EN 13869.   Measures taken by economic operators: Recall of the product from end users, Warning consumers of the risks, Withdrawal of the product from the market (By: Other)

Share on             Alert number: A12/0158/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Cadillac   Name: Escalade   Type / number of model:  Type-approval number: e13*2007/46*1479*00 Type: K2XX   Batch number / Barcode:  The vehicles concerned were manufactured in 2015.   Risk type:  Injuries   The software is faulty which may lead to sporadic failure of the electric power steering. The driver might consequently lose control of the vehicle.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0159/19        Category:  Motor vehicles   Product:  Motorcycle   Brand: Yamaha   Name: Tricity, MWS125, MWS125A, MWS150A   Type / number of model:  Type-approval number: e13*168/2013*00049 Type: SEC 2   Batch number / Barcode:  The vehicles concerned were produced between 2017 and 2018.   Risk type:  Injuries   Poor material resistance of the hoses in the area of the cooling water expansion tank can lead to the loss of cooling water. The cooling liquid could leak onto the road and the rider could consequently lose control of the motorcycle.    Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0160/19        Category:  Motor vehicles   Product:  Passenger car   Brand: VW   Name: Touareg   Type / number of model:  Type-approval number: e1*2007/46*1827*; Type: CR   Batch number / Barcode:  The vehicles in question were produced between 8/8/2018 and 5/10/2018.   Risk type:  Injuries   A seat-belt latch may not have been sufficiently secured to the rear, right-hand seat. In the event of an accident, the rear seat-belt latch may therefore break, increasing the risk of injuries to passengers.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0161/19        Category:  Motor vehicles   Product:  Passenger Car   Brand: Bentley   Name: Mulsanne   Type / number of model:  Type approval numbers: e11*KS07/46*0116*00, e11*KS07/46*0116*01, e11*KS07/46*0116*02, e11*KS07/46*0116*03, e11*KS07/46*0116*04, e11*KS07/46*0116*05   Batch number / Barcode:  The affected vehicles were manufactured between 08/03/2012 and 21/07/2018   Risk type:  Injuries   The body mounting panels of the rear seatbelt buckle anchorages have been made using an incorrect grade of material. In the event of an impact accident, if the rear centre seat is occupied at the same time as an outer rear seat, the rear seatbelt buckle may become detached from the bodywork, leading to injuries.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0162/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Mercedes-Benz   Name: A-class   Type / number of model:  Type-approval number: e1*2007/46*1829*03; Type: F2A   Batch number / Barcode:  The vehicles in question were manufactured between 13/11/2017 and 22/08/2018.   Risk type:  Injuries   No perforation has been made in the outer covering of the instrument panel to enable the deployment of the passenger airbag. In the event of an accident involving deployment of the airbag at low temperatures, sharp edges could be created on the instrument panel in the airbag's deployment area, damaging the airbag. Moreover, parts of the instrument panel may become detached, increasing the risk of injury to the occupants.    Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0163/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Mercedes-Benz   Name: C-class, GLC   Type / number of model:  EC type approvals: e1*2001/116*0480*23-30, e1*2007/46*1884*00, e1*2001/116*0431*48-50, e1*2001/116*0457*35-41, e1*2001/116*0463*20, e1*2001/116*0464*22 Types: 204, -X, -X AMG, -K, -K AMG, -AMG   Batch number / Barcode:  The vehicles in question were manufactured between 1 August 2017 and 11 October 2018.   Risk type:  Injuries   In vehicles with automatic child-seat detection, the status shown in the centre console of the passenger airbags may not be correctly indicated. In this case, the vehicle users would not be correctly informed of the actual activation status of the passenger airbag and may not react appropriately to a potentially false passenger classification, thereby increasing the risk of injury for passengers in the event of an accident.    Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0164/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Mercedes-Benz   Name: C-class, E-class, CLS   Type / number of model:  EC type-approvals: e1*2001/116*0431, e1*2001/116*0457, e1*2001/116*0501, e1*2007/46*1560, e1*2007/46*1818, e1*2001/116*0464, e1*2001/116*0463, e1*2007/46*1666*08 , Types: 204, 204 K, 212, R1ES, R1ECLS, 204 AMG, 204 K AMG, R1EC   Batch number / Barcode:  The vehicles in question were produced between 14 February 2014 and 16 December 2018.   Risk type:  Injuries   There may be cracks in a securing nut in the steering gear of rear-wheel-drive vehicles. The nut could consequently break if the steering system is subject to a very high lateral force, which could result in rotating parts in the steering gear affecting the casing and thereby blocking the steering system.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0170/19        Category:  Motor vehicles   Product:  Tyres   Brand: Continental   Name: Winter Contact TS860   Type / number of model:  ECE type approvals: R30: E4 0289778; R117: E4 027400 S2WR2   Batch number / Barcode:  This concerns one week of the manufacturing year 2018 identified by the following code: DOT 6GAED29W4118.   Risk type:  Injuries   Loosening of the tread could occur. This could have an adverse effect on the handling and stability of the vehicle.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0171/19        Category:  Motor vehicles   Product:  Tyres   Brand: Uniroyal   Name: MS Plus 77   Type / number of model:  ECE type approvals: R30: E4 0268280; R117: E4 025045 S2WR2   Batch number / Barcode:  This concerns one week of the manufacturing year 2018 identified by the following code: DOT 6GXWDDBR4118.   Risk type:  Injuries   Loosening of the tread could occur. This could have an adverse effect on the handling and stability of the vehicle.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0175/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Jeep   Name: Cherokee, Compass   Type / number of model:  EC type-approvals: e4*2007/46*0783*11, e11*2007/46*4037*02; Types: KL, MX   Batch number / Barcode:  The vehicles concerned were produced between 17 March 2018 and 21 June 2018.   Risk type:  Injuries   Incorrect coating of the brake pistons can result in the formation of gas in the hydraulic system. This may adversely affect the functioning of the brakes on the rear-axle wheels.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0176/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Alfa Romeo   Name: Stelvio   Type / number of model:  EC type-approval: e3*2007/46*0435*02; Type: 949; sales description: Stelvio   Batch number / Barcode:  The vehicles concerned were produced between 18 January 2017 and 18 September 2018.   Risk type:  Fire   A non-compliant generator cable may be damaged as a result of contact with the exhaust gas recirculation line. This could cause a short-circuit and in the worst case fire in the engine compartment.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0178/19        Category:  Motor vehicles   Product:  Vehicle component   Brand: JOST   Name: KLK HE 1200-22; KLK HE 1300-22   Type / number of model:  Unknown   Batch number / Barcode:  Period of manufacture: December 2016 to 16.11.2018.   Risk type:  Injuries   Owing to a defect in the continuous steel casting process, the ball-bearing turntables may break. Consequently, the connection to the lower turntable of a trailer may be lost, which could lead to an accident.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer) Company recall page:  https://www.jost-klk.com/en/

Share on             Alert number: A12/0183/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Opel   Name: Zafira   Type / number of model:  Type-approval numbers: e1*2001/116*0325*00-11, e1*2007/46*0497*00-05 Type: A-H/monocab   Batch number / Barcode:  The vehicles concerned were manufactured between 2 November 2004 and 24 October 2014.   Risk type:  Fire   There is a defective regulator on the blower motor. This can cause a fire in the cable set.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0185/19        Category:  Motor vehicles   Product:  Passenger Car   Brand: Land Rover   Name: Range Rover, Sport, Velar, Discovery   Type / number of model:  Range Rover E11*2007/46*0649 Range Rover Sport E11*2007/46*0909 Range Rover Velar E11*2007/46*3954 Discovery E11*2007/46*3784   Batch number / Barcode:  Specific vehicles built between 10/10/2018 and 19/12/2018   Risk type:  Injuries   The crankshaft pulley retaining bolt may fracture. As a consequence, the crankshaft nose could break leading to engine power loss and the potential for engine failure. Furthermore, the loose pulley could damage under bonnet components or puncture the bonnet and become a hazard to pedestrians or other road users.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0188/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Porsche   Name: 991 Carrera, Cayenne, Macan, Panamera   Type / number of model:  Type-approval numbers: se13*2007/46*1187 e13*2007/46*1085* e13*2007/46*1106* e13*2007/46*1107* e13*2007/46*1108* e13*2007/46*1164* e13*2007/46*0970* e13*2007/46*1143* e13*2007/46*1160* , e13*2007/46*1161*; types: 991, 92A, 95B, 970;   Batch number / Barcode:  The vehicles concerned were produced in 2014 and 2015   Risk type:  Injuries   It is possible that the vehicles do not meet the series standards applicable at the time of delivery as regards certain safety systems and assemblies (e.g. seating, front axle control arm bolts, brake components). As a consequence, the cars might be unsafe.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0192/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Jaguar   Name: F-Pace, F-Type, XJ   Type / number of model:  F-PACE E11*2007/46*3324 F-TYPE E11*2001/116*0272 XJ E11*2007/46*0089   Batch number / Barcode:  Specific vehicles built between 12/10/2018 and 11/12/2018   Risk type:  Injuries   The crankshaft pulley retaining bolt may fracture. As a consequence, the crankshaft nose could break leading to engine power loss and the potential for engine failure. Furthermore, the loose pulley could damage under bonnet components or puncture the bonnet and become a hazard to pedestrians or other road users.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0193/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Land Rover   Name: Range Rover, Range Rover Sport   Type / number of model:  Type Approval Number : Range Rover E11*2007/46*0649 Range Rover Sport E11*2007/46*0909   Batch number / Barcode:  Specific vehicles built between 10/11/2017 and 18/12/2018 and fitted with the 4.4L SDV8 diesel engines   Risk type:  Injuries   Due to a faulty software, the directional indicators may fail to operate when the steering column mounted control stalks are used and the driver does not receive visual or audible warnings if this occurs. As a consequence, there is an increased risk of a crash.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0194/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Bentley   Name: Continental GT   Type / number of model:  Type approval numbers: e13*2007/46*0634*01 e13*2007/46*0634*02   Batch number / Barcode:  Specific vehicles built between 22/01/2018 and 17/12/2018   Risk type:  Injuries   Due to a software fault a temporary loss of power assistance could occur, requiring the driver to apply additional steering force. This could lead to an accident.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

1 of 6 photos PreviousNext Share on             Alert number: A12/0157/19        Category:  Other   Product:  Smart watch for children   Brand: ENOX   Name: Safe-KID-One   Type / number of model:  Unknown   Batch number / Barcode:  4260088660947   Risk type:  Other   The mobile application accompanying the watch has unencrypted communications with its backend server and the server enables unauthenticated access to data. As a consequence, the data such as location history, phone numbers, serial number can easily be retrieved and changed. A malicious user can send commands to any watch making it call another number of his choosing, can communicate with the child wearing the device or locate the child through GPS.  The product does not comply with the Radio Equipment Directive.   Measures ordered by public authorities (to: Distributor): Recall of the product from end users

1 of 3 photos PreviousNext Share on             Alert number: A12/0152/19        Category:  Toys   Product:  Toy scooter   Brand: illumination   Name: Despicable Me DM3   Type / number of model:  808580   Batch number / Barcode: Unknown   Risk type:  Injuries   The scooter is not sufficiently stable. Children can fall to the ground and hurt themselves.  The product does not comply with the requirements of the Toy Safety Directive and with the relevant European Standard EN 71-1.   Measures taken by economic operators: Destruction of the product (By: Importer) Measures ordered by public authorities (to: Importer): Import rejected at border

1 of 1 photo Share on             Alert number: A12/0168/19        Category:  Toys   Product:  Children's fancy-dress costume   Brand: Unknown   Name: ABYED - Anime Animal Costume Cosplay   Type / number of model:  Unknown   Batch number / Barcode: Unknown   Risk type:  Choking   The slider of the zip can be easily detached. A child could put it in the mouth and choke on it.  The product does not comply with the requirements of the Toy Safety Directive and the relevant European Standard EN 71-1.   Measures taken by economic operators: This product listing was removed by AMAZON, Withdrawal of the product from the market (By: Other)

1 of 4 photos PreviousNext Share on             Alert number: A12/0182/19        Category:  Toys   Product:  Pull-along toy   Brand: ECOTOYS   Name: Drewniany piesek na sznurku   Type / number of model:  Item N0. 2205   Batch number / Barcode:  4 894063 031592 Seria 07/2016   Risk type:  Strangulation   The cord attached to the toy is too long. The cord could wrap itself around the child's neck without the child being able to remove it, causing strangulation. The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-1.   Measures ordered by public authorities (to: Importer): Making the marketing of the product subject to prior conditions

1 of 1 photo Share on             Alert number: A12/0184/19        Category:  Toys   Product:  Educational toy   Brand: Makeblock   Name: mBot   Type / number of model:  FRA mBot V1.1-Blue (bluethooth version)   Batch number / Barcode: Unknown   Risk type:  Burns, Chemical   Due to a short-circuit, the batteries can overheat and the plastic of the battery compartment can melt. Moreover, the battery compartment of the remote-control can easily be opened without use of any tools, giving access to the button cell batteries. A child may sustain burns from the overheating parts or put the batteries in the mouth and swallow them, which can cause damage to the child's gastrointestinal tract.  The product does not comply with the requirements of the Toy Safety Directive and the relevant European standards EN 62115 and EN 71-1.   Measures ordered by public authorities (to: Importer): Import rejected at border

1 of 2 photos PreviousNext Share on             Alert number: A12/0191/19        Category:  Toys   Product:  Squeezable toy   Brand: Unknown   Name: Children's toy   Type / number of model:  Unknown   Batch number / Barcode: Unknown   Risk type:  Chemical   The plastic material of the product contains di-(2-ethylhexyl) phthalate (DEHP) (measured value: 12% by weight) and diisobutyl phthalate (DIBP) (26% by weight). These phthalates may harm the health of children causing possible damage to the reproductive system. The product does not comply with the REACH Regulation.   Measures ordered by public authorities (to: Other): Withdrawal of the product from the market

1 of 1 photo Share on             Alert number: A12/0195/19        Category:  Toys   Product:  Soft toy   Brand: Unknown   Name: Soft toy turtle, 18 cm   Type / number of model:  Unknown   Batch number / Barcode: Unknown   Risk type:  Chemical, Choking   The eyes and the suction cup can easily be detached and the paint on the eyes contains lead (measured value: 63 mg/kg) The fibrous stuffing material of the toy is easily accessible due to the weakness of certain seams. A small child may put the small parts, the suction cup or the stuffing material in the mouth and choke. Exposure to lead is harmful for human health and can cause developmental neurotoxicity. The product does not comply with the requirements of the Toy Safety Directive and with the relevant European standards EN 71-1 and EN 71-3.   Measures taken by economic operators: Withdrawal of the product from the market (By: Other)

1 of 2 photos PreviousNext Share on             Alert number: A12/0196/19        Category:  Toys   Product:  Electric toy   Brand: Unknown   Name: Funny microphone   Type / number of model:  NO. 729   Batch number / Barcode: Unknown   Risk type:  Environment   Four solders in the toy contain lead (measured value up to 44.8% by weight) and two of the four solders contain cadmium (measured value up to 0.66% by weight) in concentrations above limit values. Lead and cadmium pose a risk to the environment. The product does not comply with the Commission Directive on the restriction of the use of certain hazardous substances in electrical and electronic equipment (RoHS 2 Directive).    Measures taken by economic operators: Withdrawal of the product from the market (By: Importer)

1 of 2 photos PreviousNext Share on             Alert number: A12/0200/19        Category:  Toys   Product:  Science kit   Brand: Alga   Name: Electro Alarm   Type / number of model:  21928505   Batch number / Barcode:  4893669285057   Risk type:  Environment   Solder in one place in the toy contains lead in concentration above limit value (measured value up to 11.7% by weight). Lead poses a risk to the environment.  The product does not comply with the Commission Directive on the restriction of the use of certain hazardous substances in electrical and electronic equipment (RoHS 2 Directive).   Measures taken by economic operators: Withdrawal of the product from the market (By: Manufacturer)

1 of 5 photos PreviousNext Share on             Alert number: A12/0165/19        Category:  Clothing, textiles and fashion items   Product:  Children's dress   Brand: Lamond   Name: Lány ruha   Type / number of model:  999-0521-3   Batch number / Barcode: Unknown   Risk type:  Choking, Injuries   The small decorative rhinestones can easily be detached from the dress.  A small child may put them in the mouth and choke. The sharp safety pin of the decorative flower is easily accessible. A small child may put the small parts in the mouth and choke, while the safety pin can cause eye or skin injuries.   Measures ordered by public authorities (to: Distributor): Recall of the product from end users, Withdrawal of the product from the market

1 of 4 photos PreviousNext Share on             Alert number: A12/0166/19        Category:  Clothing, textiles and fashion items   Product:  Babies' clothing set   Brand: Petite Ponpon Baby   Name: Unknown   Type / number of model:  Unknown   Batch number / Barcode: Unknown   Risk type:  Choking   The small decorative elements of the product may be easily detached. A small child may put them in the mouth and choke.   Measures ordered by public authorities (to: Distributor): Recall of the product from end users, Withdrawal of the product from the market

1 of 4 photos PreviousNext Share on             Alert number: A12/0169/19        Category:  Clothing, textiles and fashion items   Product:  Ladies' sandals   Brand: ElleNor   Name: Damen Pantolette   Type / number of model:  Unknown   Batch number / Barcode:  4039653754509   Risk type:  Chemical   The amount of chromium (VI) in the leather of the insoles is too high (measured value 12.4 mg/kg). Chromium (VI) is sensitising and may trigger allergic reactions. The product does not comply with the REACH Regulation.   Measures taken by economic operators: Recall of the product from end users (By: Importer)

1 of 5 photos PreviousNext Share on             Alert number: A12/0186/19        Category:  Clothing, textiles and fashion items   Product:  Children's sweatshirt   Brand: RITCHIE JEANS CO   Name: Deška jopa   Type / number of model:  RT7394X, Reference: WIPACK J   Batch number / Barcode:  3660283413408   Risk type:  Strangulation   There are drawstrings with free ends in the hood. The drawstrings may become trapped during various activities of the child, leading to strangulation. The product does not comply with the relevant European standard EN 14682.   Measures taken by economic operators: Making the marketing of the product subject to prior conditions (By: Distributor)

1 of 4 photos PreviousNext Share on             Alert number: A12/0187/19        Category:  Clothing, textiles and fashion items   Product:  Children's sweatshirt   Brand: LONGBOARD   Name: Deška jopa   Type / number of model:  JUST MUVE, Reference 46974000   Batch number / Barcode:  3253538179817   Risk type:  Strangulation   There are drawstrings with free ends in the hood. The drawstrings may become trapped during various activities of the child, leading to strangulation. The product does not comply with the relevant European standard EN 14682.   Measures taken by economic operators: Making the marketing of the product subject to prior conditions (By: Distributor)

1 of 4 photos PreviousNext Share on             Alert number: A12/0173/19        Category:  Cosmetics   Product:  Hair dye   Brand: Color Mate   Name: Hair Color   Type / number of model:  Light Brown 9.7   Batch number / Barcode:  8 906016 050843 Batch Number: 07   Risk type:  Chemical   The product contains barium (measured value: 13.6 % by weight) as peroxide. Barium peroxide is corrosive and irritant. Barium can be absorbed from the dye and have toxic effects on kidney and heart. The product contains too much p-aminophenol (measured value: 13.6% by weight, final calculated concentration: 3.8%) and insufficient coupling agent. Uncoupled p-aminopohenol is a strong skin sensitiser and may trigger allergic skin reactions. The product does not comply with the Cosmetic Products Regulation.   Measures ordered by public authorities (to: Retailer): Destruction of the product

1 of 2 photos PreviousNext Share on             Alert number: A12/0153/19        Category:  Electrical appliances and equipment   Product:  USB-Charger   Brand: Samsung (Counterfeit)   Name: Samsung EP-TA20EWE (Counterfeit)   Type / number of model:  EP-TA20EWE   Batch number / Barcode: Unknown THE PRODUCT IS COUNTERFEIT   Risk type:  Electric shock   The electrical insulation and the clearance/creepage distances between the primary and accessible secondary circuit are not sufficient. The user could touch accessible live parts and receive an electric shock. The product does not comply with the requirements of the Low Voltage Directive and the relevant European standard EN 60950.   Measures ordered by public authorities (to: Other): Withdrawal of the product from the market

1 of 2 photos PreviousNext Share on             Alert number: A12/0154/19        Category:  Electrical appliances and equipment   Product:  USB-Charger   Brand: Unknown   Name: EP-TA20EWE   Type / number of model:  EP-TA20EWE   Batch number / Barcode:  86696806738   Risk type:  Electric shock   The electrical insulation and the clearance /creepage distances between the primary and accessible secondary circuit are not sufficient. The user could touch accessible live parts and receive an electric shock. The product does not comply with the requirements of the Low Voltage Directive and the relevant European standard EN 60950.   Measures ordered by public authorities (to: Other): Withdrawal of the product from the market

1 of 3 photos PreviousNext Share on             Alert number: A12/0155/19        Category:  Electrical appliances and equipment   Product:  USB-Charger   Brand: Unknown   Name: Unknown   Type / number of model:  keke-f5   Batch number / Barcode: Unknown   Risk type:  Electric shock   The electrical insulation and the clearance/creepage distances between the primary and accessible secondary circuit are not sufficient. The user could touch accessible live parts and receive an electric shock. The product does not comply with the requirements of the Low Voltage Directive and the relevant European standard EN 60950.   Measures ordered by public authorities (to: Other): Withdrawal of the product from the market

1 of 2 photos PreviousNext Share on             Alert number: A12/0156/19        Category:  Electrical appliances and equipment   Product:  USB-Charger   Brand: Unknown   Name: Unknown   Type / number of model:  EP-TA20JWE   Batch number / Barcode:  S/N R37G15Z7JP1RT3   Risk type:  Electric shock   The electrical insulation and the clearance/creepage distances between the primary and accessible secondary circuit are not sufficient. The user could touch accessible live parts and receive an electric shock. The product does not comply with the requirements of the Low Voltage Directive and the relevant European standard EN 60950.   Measures ordered by public authorities (to: Other): Withdrawal of the product from the market

Weekly overview report on professional products

Serious risk 

Share on             Alert number: A12/0167/19        Category:  Motor vehicles   Product:  Lorry   Brand: Mitsubishi Fuso   Name: eCanter   Type / number of model:  Type-approval number: E4*2007/46*0785*; Type: FE4P10TF1N2   Batch number / Barcode:  The vehicles concerned were produced between September 2017 and December 2017.   Risk type:  Burns, Fire, Injuries   Owing to a defective power distribution unit (PDU), short circuits in the vehicle electronics may occur. Increased resistance or a power interruption may occur and/or, where currents are high, a thermal event may ensue. This could lead to the vehicle breaking down or catching fire.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0177/19        Category:  Motor vehicles   Product:  Lorry   Brand: Mercedes-Benz   Name: Econic   Type / number of model:  Type-approval number: e1*2007/46*1221* Type: NGE-L64   Batch number / Barcode:  The vehicles in question were manufactured between 1 October 2013 and 26 July 2018.   Risk type:  Injuries   Pneumatic brake lines on the parking brake may, under certain conditions, be damaged by chafing on the drive shafts when the vehicle is lowered to the lowest position. As a result, it could, over time, cause the wheels to jam when applying the brakes.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0197/19        Category:  Motor vehicles   Product:  Lorry   Brand: Mercedes-Benz   Name: Unimog   Type / number of model:  Type-approval numbers: e1*2007/46*1214, *1215, *1216 Types: UGE-452, UGE-232, UGE-453   Batch number / Barcode:  The vehicles affected were produced between August 2013 and January 2018.   Risk type:  Injuries   There is a possible damage to the electrical wiring harness. This may affect the functioning of the rear lighting unit (including trailer), the electrical supply to the cab, the motor control module (MCM) and the anti-lock braking system (ABS) of the rear axle.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0198/19        Category:  Motor vehicles   Product:  Lorry   Brand: Scania   Name: 4-, G-, P-, R-series and possibly others   Type / number of model:  EC type-approvals: e4*2007/46*0030, *0031, *0032, *0038, *0039, *0040, *0045, *0046, *0605 and possibly other types: N320, N321, N322, N330, N331, N332, N340, N341, N351.   Batch number / Barcode:  The vehicles affected were produced between 2007 and June 2017.   Risk type:  Injuries   Defective alignment of the steering geometry, or inadequate alignment of the steering stops, may result in chafing of the wheels on the steering column. As a result, the steering column might break, leading to a loss of steering control.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

Share on             Alert number: A12/0199/19        Category:  Motor vehicles   Product:  Bus   Brand: EvoBus   Name: Sprinter Transfer, Sprinter Mobility   Type / number of model:  EC type-approvals: e13*2007/46*1295, e13*2007/46*1294 Types: KA-UM/UL/UXL-M2, KA-UM/UL/UXL-M3   Batch number / Barcode:  The vehicles concerned were manufactured between June 2010 and July 2018.   Risk type:  Injuries   The inbuilt microphone for tour guide announcements is located in the passenger airbag's inflation zone. If the airbag were activated, it could be damaged.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)