Nurse-led dexmedetomidine sedation for magnetic resonance imaging in children: a 6-year quality improvement project

We aimed to safely introduce dexmedetomidine into a nurse-led sedation service for magnetic resonance imaging in children. Secondary aims were to increase the number of children eligible for sedation and to increase the actual number of children having sedation performed by our nurse sedation team. We analysed 1768 consecutive intravenous and 219 intranasal dexmedetomidine sedation episodes in infants, children and adolescents having magnetic resonance imaging scans between March 2016 and March 2022. The overall sedation success rate was 98.4%, with a 98.9% success rate for intravenous dexmedetomidine and a 95.0% success rate for intranasal dexmedetomidine. The incidence of scan interruption during intravenous and intranasal dexmedetomidine sedation was 8.8% and 21.9%, respectively. We conclude that paediatric sedation with dexmedetomidine for magnetic resonance scanning is safe and successful.     

Explained and unexplained racial and regional inequality in obesity prevalence in the United States

ABSTRACT

Objective: There are substantial racial and regional disparities in obesity prevalence in the United States. This study partitioned the mean Body Mass Index (BMI) and obesity prevalence rate gaps between non-Hispanic blacks and non-Hispanic whites into the portion attributable to observable obesity risk factors and the remaining portion attributable to unobservable factors at the national and the state levels in the United States (U.S.) in 2010.

Design: This study used a simulated micro-population dataset combining common information from the Behavioral Risk Factor Surveillance System and the U.S. Census data to obtain a reliable, large sample representing the adult populations at the national and state levels. It then applied a reweighting decomposition method to decompose the black-white mean BMI and obesity prevalence disparities at the national and state levels into the portion attributable to the differences in distribution of observable obesity risk factors and the remaining portion unexplainable with risk factors.

Results: We found that the observable differences in distribution of known obesity risk factors explain 18.5% of the mean BMI difference and 20.6% of obesity prevalence disparities between non-Hispanic blacks and non-Hispanic whites. There were substantial variations in how much the differences in distribution of known obesity risk factors can explain black-white gaps in mean BMI (?67.7% to 833.6%) and obesity prevalence (?278.5% to 340.3%) at the state level.

Conclusion: The results from this study demonstrate that known obesity risk factors explain a small proportion of the racial, ethnic and between-state disparities in obesity prevalence in the United States. Future etiologic studies are required to further understand the causal factors underlying obesity and racial, ethnic and geographic disparities.     

EGFR、p53在db/db自发性糖尿病小鼠颌下腺的表达

目的 观察表皮生长因子受体（EGFR）、p53在糖尿病小鼠颌下腺中的表达。方法 选取3、4、6、8、10月龄db／db糖尿病小鼠及相应月龄的db／＋m正常小鼠颌下腺。应用HE染色及免疫组织化学方法染色后进行图像分析，统计EGFR、p53在颌下腺组织内表达的细胞阳性率。结果 随着糖尿病的发展，颌下腺组织出现腺叶萎缩及实质细胞排列不整齐，堆集呈簇。纤维及血管增多；EGFR、p53在对 照组及糖尿病组颌下腺中均有表达。其细胞阳性率随月龄增大均呈增高趋势。且糖尿病组显著高于对照组。结论 ①db／db糖尿病可导致颌下腺组织萎缩及实质细胞形态学改变。②EGFR、p53表达增多。说明糖尿病时EGFR作为多效应受体，可能被激活从而诱导了颌下腺的细胞凋亡；p53表达的上升。提示随着糖尿病发展，颌下腺实质细胞有凋亡趋势。     

Meta-analysis of retrojugular versus antejugular approach for carotid endarterectomy

Introduction

The retrojugular approach for carotid endarterectomy (CEA) has been reported to have the advantages of shorter operative time and ease of dissection, especially in high carotid lesions. Controversial opinion exists with regard to its safety and benefits over the conventional antejugular approach.

Methods

A systematic review of electronic information sources was conducted to identify studies comparing outcomes of CEA performed with the retrojugular and antejugular approach. Synthesis of summary statistics was undertaken and fixed or random effects models were applied to combine outcome data.

Findings

A total of 6 studies reporting on a total of 740 CEAs (retrojugular approach: 333 patients; antejugular approach: 407 patients) entered our meta-analysis models. The retrojugular approach was found to be associated with a higher incidence of laryngeal nerve damage (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 1.46–7.07). No significant differences in the incidence of hypoglossal or accessory nerve damage were identified between the retrojugular and antejugular approach groups (OR: 1.09 and 11.51, 95% CI: 0.31–3.80 and 0.59–225.43). Cranial nerve damage persisting during the follow-up period was similar between the groups (OR: 2.96, 95% CI: 0.79–11.13). Perioperative stroke and mortality rates did not differ in patients treated with the retrojugular or antejugular approach (OR: 1.26 and 1.28, 95% CI: 0.31–5.21 and 0.25–6.50).

Conclusions

Currently, there is no conclusive evidence to favour one approach over the other. Proof from a well designed randomised trial would help determine the role and benefits of the retrojugular approach in CEA.