The effectiveness of pelvic floor exercise on urinary incontinence in radical prostatectomy patients

Urinary incontinence (UI) is a major complication among patients after radical prostatectomy (RP). Although previous research supports the efficacy of pelvic floor exercises for male UI, there are both positive and no significant effects. The purpose of this study was to examine the effect of pelvic floor exercises on UI after RP. This was a quasi‐experimental, randomized, mixed‐method study design. All participants were older than 45 years and had undergone an RP. Outcome measurements included a 1‐h pad test, personal demographics, and disease‐related data. After catheter removal, participants were distributed into either an exercise group (n = 39) or a non‐exercise group (n = 28). Patients in the exercise group took part in a pelvic floor exercise during their regular daily activities. The non‐exercise group did not perform the prescribed exercise. We examined urinary function at 1, 3 and 6 months after catheter removal. Following a mixed‐model anova test for differences, the results of the pad test revealed significant differences for the main effect of time (F = 75·30,P < 0·001), indicating that the amount of urine leakage decreased over time regardless of the group. Results for the main effect of group were statistically significant (F = 8·85,p < 0·01), indicating that urine leakage also decreased over time in both groups, but that urinary control in the exercise group was better than in the non‐exercise group. Although improvements in surgical technique have significantly improved the outcome of prostate surgery, we believe that patient education regarding pelvic floor exercises by a nurse prior to and after surgery has a significant impact on the early recovery of urinary continence. We believe these exercises would certainly have a positive impact on our patients undergoing RP by improving the quality of life after major urological surgery.     

Rapid and validated fluorometric HPLC method for determination of gabapentin in human plasma and urine for clinical application

What is known and Objective: A rapid derivatization and validated HPLC method for gabapentin in human plasma and urine is needed for clinical use. The objective of this study was to establish a rapid and validated analytical method for the determination of gabapentin in human plasma and urine using isocratic fluorometric HPLC for clinical application. Methods: This analytical method is based on precolumn fluorescent derivatization using 4‐fluoro‐7‐nitro‐benzofurazan. The derivatization was coupled to fast HPLC separation using a 2·3 μm‐particle size ODS column (100 × 4·6 mm i.d.). Results and Discussion: The derivatization of gabapentin was optimized and HPLC separation was achieved over an ODS column with a run time of 3·5 min. Calibration curves in human plasma and urine were linear over the concentration ranges of 0·05–10 and 10–1000 μg/mL, respectively. Intra‐ and inter‐assay precision and accuracy values of plasma were within 8·0% and 101–109% and within 8·3% and 94–108%, respectively. Those of urine were within 8·5% and 97–106% and within 9·5% and 97–105%, respectively. This validated method was applied to a pharmacokinetic study in healthy subjects. Interindividual variations in plasma disposition and urinary excretion of gabapentin were observed. What is new and Conclusion: A rapid and validated isocratic fluorometric HPLC method for the determination of gabapentin in human plasma and urine for clinical application has been established. This method can be utilized to evaluate the pharmacokinetic disposition of gabapentin in humans.     

Bone mineral density of visually handicapped women

While physical activity is an essential factor for muscle performance and development and also for the maintenance of bone mass in the loaded bones, apparently low intensity of physical activity of blind persons may compromise the muscle performance and bone mineral density (BMD). Therefore, the aim was to study whether there are differences in BMD of the weight‐bearing or non‐weight‐bearing bones between visually handicapped persons and those with normal sight. Nineteen visually handicapped premenopausal women and their matched pairs were recruited to the study. The mean age of the visually handicapped women was 39·9 years (SD 8·1) and that of the women with normal vision 39·7 years (6·5). BMD of the distal radius, femoral neck and trochanter was measured with dual energy X‐ray absorptiometry (DXA), and isometric muscle strength of the extremities and trunk with a dynamometer. Between‐group differences were compared with paired Student’s t‐test. The BMD at the femur was 8% higher in favour of the group with normal sight, whereas radial BMD was similar in the two groups. The t‐score was ?1·0 (95% confidence interval ?1·5 to ?0·5) for the femoral neck BMD and ?0·7 (?1·1 to ?0·2) for the trochanter BMD in the group with impaired vision. The respective t‐scores for the group with normal sight were ?0·3 (?0·9 to 0·3) for the femoral neck and 0 (?0·7 to 0·7) for the trochanter. Visual handicap seems to be a risk for lower BMD of the weight‐bearing proximal femur, but not for lower BMD of the non‐weight‐bearing distal radius.     

Population pharmacokinetics of caffeine in healthy male adults using mixed-effects models

Objective: Caffeine has been shown to maintain or improve the performance of individuals, but its pharmacokinetic profile for Asians has not been well characterized. In this study, a population pharmacokinetic model for describing the pharmacokinetics of caffeine in Singapore males was developed. The data were also analysed using non‐compartmental models. Methods: Data gathered from 59 male volunteers, who each ingested a single caffeine capsule in two clinical trials (3 or 5 mg/kg), were analysed via non‐linear mixed‐effects modelling. The participants’ covariates, including age, body weight, and regularity of caffeinated‐beverage consumption or smoking, were analysed in a stepwise fashion to identify their potential influence on caffeine pharmacokinetics. The final pharmacostatistical model was then subjected to stochastic simulation to predict the plasma concentrations of caffeine after oral (204, 340 and 476 mg) dosing regimens (repeated dosing every 6, 8 or 12 h) over a hypothetical 3‐day period. Results: The data were best described by a one‐compartmental model with first‐order absorption and first‐order elimination. Smoking status was an influential covariate for clearance: clearance (mL/min) = 110*SMOKE + 114, where SMOKE was 0 and 1 for the non‐smoker and the smoker respectively. Interoccasion variability was smaller compared to interindividual variability in clearance, volume and absorption rate (27% vs. 33%, 10% vs. 15% and 23% vs. 51% respectively). The extrapolated elimination half‐lives of caffeine in the non‐smokers and the smokers were 4 · 3 ± 1 · 5 and 3 · 0 ± 0 · 7 h respectively. Dosing simulations indicated that dosing regimens of 340 mg (repeated every 8 h) and 476 mg (repeated every 6 h) should achieve population‐averaged caffeine concentrations within the reported beneficial range (4 · 5–9 μg/mL) in the non‐smokers and the smokers respectively over 72 h. Conclusion: The population pharmacokinetic model satisfactorily described the disposition and variability of caffeine in the data. Mixed‐effects modelling showed that the dose of caffeine depended on cigarette smoking status.     

Characteristics of hypertension‐related factors in female home caregivers in Japan—comparison with general community non‐caregivers

Aims and objectives. To examine the characteristics of hypertension‐related factors in female family caregivers in Japan who provide care in the home, in comparison with general community non‐caregivers. Background. Hypertension is more frequently encountered in female caregivers than in non‐caregivers. Lifestyle factors including sleep and eating habits differ in Japanese female caregivers and the general population. Therefore, hypertension‐related factors in caregivers may also differ from those in the general population. Design. A cross‐sectional study. Methods. The subjects were 150 female caregivers (aged 62·4, SD 12·2 years) who provided home care for persons with physical impairments and/or dementia and 154 female controls (aged 62·7, SD 2·2 years) who did not provide home care. Persons with a history of ischaemic heart disease or cerebral stroke were excluded. Subjects were examined using a self‐reporting questionnaire that included a food frequency questionnaire and the tri‐axial coping scale. Urine examinations and blood pressure measurements were also done. Logistic regression analysis was conducted for each group with the same variables as explanatory variables. Results. Hypertension was present in 46·7% of caregivers and 34·4% of controls (p < 0·05). Menopause was a factor related to hypertension in both the caregivers and controls. In the caregiver group, hypertension was associated with the estimated 24‐h Na excretion in urine and the carbohydrate‐energy ratio for nutriti. BMI was associated with hypertension in the control group, but not in the caregiver group. Conclusions. Hypertension was associated with nutritional factors, such as greater Na excretion in urine and higher carbohydrate energy ratio, in Japanese female caregivers and with obesity in non‐caregivers. Relevance to clinical practice. To prevent hypertension, it is necessary to carefully monitor salt intake and nutritional balance in female caregivers in Japan.     

Post‐operative pain relief following intrathecal injection of acetylcholine esterase inhibitor during lumbar disc surgery: a prospective double blind randomized study

Background: As spinal cholinergic receptors participate in the control of somatic pain, this effect could be potentiated by intrathecal injection of a cholinesterase inhibitor, neostigmine. Objective: This study was designed to evaluate the effectiveness of intrathecal administration of neostigmine on pain relief after single level lumbar disectomy. Methods: Sixty‐six patients with unilateral extruded lumbar disc were randomly allocated into two groups, neostigmine (‘N’), and control (‘C’); the former received 100 μg of neostigmine methylsulphate, whereas the latter received placebo intrathecally after termination of the surgery. Visual Analogue Scale was employed to measure post‐operative pain, which was a primary outcome of the study. Opiate dosage consumed was also recorded as a primary outcome during the first 24 h following surgery. Nausea and vomiting although important were considered as secondary outcomes. Results: Mean Visual Analogue Scale scores post‐operatively at 1, 4 and 8 h were 2·24, 1·82 and 1·88 in group ‘N’ and 5·36, 5·61 and 4·88 in group C. Mean morphine used intravenously in the first 24 h was 0·9 mg in group ‘N’ and 4·7 mg in group C. All results were found to be significantly different in the two groups. The frequency of nausea and vomiting was not significantly different in the two groups ‘C’ (24%) and ‘N’ (18%). Conclusion: Injection of 100 μg hyperbaric neostigmine intrathecally was effective for pain relief, and reduced post‐operative opiate demand.     

Role of handedness on forearm skin tissue dielectric constant (TDC) in relation to detection of early‐stage breast cancer‐related lymphedema

skin tissue dielectric constant (TDC) measurements help assess local skin water to detect incipient early‐stage lymphedema subsequent to breast cancer treatment‐related lymphedema. However, presurgery measurements are not always obtained and assessments for evolving lymphedema are only made after surgery. Thus, subsequent TDC assessments may be biased in an unknown way dependent on a patient's handedness in relation to the at‐risk arm. We investigated this issue by comparing TDC values in dominant and non‐dominant volar forearms of 31 left‐handed women and 31 right‐handed women (age range 24–84 years). Body fat and water percentages were assessed by bioimpedance at 50 KHz. Results showed that TDC values of dominant versus non‐dominant arms did not significantly differ for left‐handers or for right‐handers. There was also no statistically significant difference in absolute TDC values between left‐ and right‐handers or a statistically significant difference in dominant‐to‐non‐dominant arm ratios between left‐ and right‐handers. For the composite data set (N = 62), TDC values for dominant and non‐dominant arms were, respectively, 30·0 ± 4·6 and 29·6 ± 4·2 and the dominant‐to‐non‐dominant arm TDC ratio for combined left‐ and right‐handers was 1·015 ± 0·075. These results suggest that handedness is not a major factor when assessing lymphedema status in women who have previously been treated for breast cancer but for whom pretreatment TDCvalues have not been obtained. Moreover, these results suggest that threshold ratios of incipient subclinical unilateral lymphedema based on interarm TDC ratios apply independent of a patient's handedness for the site and tissue depths herein measured.     

Group training for overactive bladder in female patients: a clinical,randomized, non‐blinded study

Bladder training (BT) given individually for overactive bladder symptoms (OAB) is time consuming, and patients tend to need reinforcement. We hypothesized that a specified BT programme for female OAB patients performed as group training would have the same effect as the identical programme used for individual training. A randomized, controlled, non‐blinded trial in six hospital‐situated clinics in Denmark. A total of 91 women were randomized to either individual BT or group BT (three–four patients in each group). In both settings BT was to be performed daily for a 2‐month period supported by a diary and with three training sessions at the hospital coached by a continence nurse. All analyses were performed as intention‐to‐treat. Main outcome measures were urgency episodes, urgency incontinence episodes and scores from a symptom‐specific visual analogue scale (VAS). A total of 38 women with individual BT and 41 with group BT were included in the analyses. No significant differences in urgency episodes, urgency incontinence episodes, voiding frequency between the two settings were observed after treatment. Neither did scores from the VAS scale differ. Median values showed a daily 50% reduction in urgency incontinence episodes. Daily voiding frequency of 8·5–10 was reduced to 7·5 voidings. Women were equally satisfied with the programme in both settings. Compliance in training was equal, and no serious adverse events were reported in either setting. This particular BT programme for female OAB patients showed no difference between group training and individual training with respect to clinical end points, patient satisfaction or compliance.     

Care dependency of children in Egypt

Aims. This study aimed to modify the Care Dependency Scale so that it could be used for children, to apply its Arabic version to Egyptian children to test the reliability and validity of the modified scale and to compare the care dependency of disabled and non‐disabled Egyptian children. Background. A higher dependence of children in their daily tasks undoubtedly places a greater burden on their caregivers. To estimate the extent of the problem of care dependency, data from different countries and proper standard instruments are required. Method. The Care Dependency Scale was modified for children by Delphi technique. This study assessed the care dependency of non‐disabled children compared with children with physical and mental disabilities using the modified version of the Care Dependency Scale for paediatrics. The total sample included 260 Egyptian school‐age children (50·8% of whom were disabled and 49·2% were non‐disabled). Results. Reliability was examined in terms of internal consistency using Cronbach's alpha (0·91). Inter‐rater reliability revealed moderate to very good Kappa statistics between 0·57–0·89. Content validity and criterion validity were evaluated. Differences regarding care dependency were found between disabled and non‐disabled children. Conclusion. The psychometric properties of the Care Dependency Scale for paediatrics support its usefulness in measuring the care dependency of children in Egypt. This study provides an Arabic version of the Care Dependency Scale for paediatrics that is easy to administer and may be useful to measure the care dependency in various Arabic countries. Relevance to clinical practice. The findings raise concerns regarding the extent to which disabled and also non‐disabled school‐age children are care dependent leading to an increased burden of care on nurses or on caregivers in general. The Care Dependency Scale for Paediatrics can help nurses conduct an appropriate assessment of children's care dependency so that any nursing care can be planned according to the children's needs.     

Single-dose rasburicase for tumour lysis syndrome in adults: weight-based approach

Background: The optimal rasburicase dose for adult patients has not been determined. Objective: To retrospectively examine use of rasburicase in our centre and to evaluate the effect of a single dose of rasburicase on urate and serum creatinine levels in our adult patients. Method: A retrospective chart review was conducted of all adult patients who received rasburicase for treatment of tumour lysis syndrome‐associated hyperuricaemia at our academic, urban medical centre from July 2002 to October 2006. Result: Twenty‐one patients received rasburicase with an average first dose of 0·15 ± 0·03 mg/kg. The drug dosing was calculated based on the patients’ ideal body weight (IBW) or adjusted body weight (aBW) for those who were more than 30% above their IBW. Patients experienced a mean serum urate reduction of 89·7 ± 9·0% from the baseline through the first 24 h after a single rasburicase dose (11·4 ± 4·5 mg/dL vs. 1·4 ± 1·4 mg/dL, respectively, P < 0·001). The urate levels remained within normal limits (<8 mg/dL) in all the patients for 48 h after a single dose of rasburicase. The major limitation of our study is that in 18 of 21 patients we lacked adequate documentation to ascertain that the blood samples sent for urate analysis after drug administration were handled according to the manufacturer’s recommendations. However, in this small group of patients, we observed that the effect of rasburicase on serum urate was similar to the total study population. The effect was sustained for 48 h after a single dose. Serum creatinine levels at 24–72 h after the single rasburicase dose were not significantly different from baseline (1·8 mg/dL vs. 2·3 mg/dL, respectively, P = 0·14). Conclusion: Rasburicase is an effective treatment for patients with hyperuricaemia and may aid in the prevention of hyperuricaemia‐associated nephrotoxicity. From our experience, a single dose of 0·15 mg/kg (IBW or aBW) of rasburicase appears to effectively decrease and maintain urate levels within normal limits for 48 h.     

Cerebral haemodynamics during the Mueller manoeuvre in humans

Voluntary negative intra‐thoracic pressure (Mueller manoeuvre) is known to reduce arterial blood pressure (ABP). To investigate changes in cerebral blood flow velocity (CBFV) during 15 s Mueller manoeuvres at –30 mmHg intra‐thoracic pressure, 27 young (aged 21–31 years, group A) and 11 older (52–64 years, group B) healthy adults were studied using transcranial Doppler and non‐invasive ABP measurement (Finapres). After closely following the initial ABP drop, CBFV showed an overshoot during temporary recovery of ABP. Then ABP and CBFV decreased significantly to below baseline. While ABP declined further until the end of the manoeuvre, CBFV increased in group A 4·7 s (2·4–8·5) (median and range) and in group B 5·7 s (4·1–7·2) after the onset of the CBFV decrease. Critical closing pressure (CCP), calculated for each cardiac cycle from the dynamic pressure–flow relationship (DPFR), indicated a reduction of intra‐cranial pressure during the first half of the strain. DPFR‐related estimation of cerebrovascular resistance provided a more physiological response than the conventional cerebrovascular resistance quotient ABP/CBFV, and decreased about 1·5 s before the observed CBFV increase. A modification of the previously described dynamic auto‐regulation index ROR correlated significantly with CO₂ reactivity values (r=0·61, P=0·001). In conclusion, changes in CBFV during Mueller manoeuvres are likely to reflect dynamic cerebral auto‐regulation and may provide an estimate of dynamic cerebral auto‐regulation capacity. In older adults, the maximal dynamic auto‐regulatory response seems to be unchanged, but the onset of reaction is slightly delayed.     

The susceptibility of the knee extensors to eccentric exercise‐induced muscle damage is not affected by leg dominance but by exercise order

The aims of this study were first to compare the response of dominant and non‐dominant legs to eccentric exercise and second, to examine whether there is an effect of exercise order on the magnitude of symptoms associated with intense eccentric protocols. Eighteen young men performed three sets of 30 maximal eccentric isokinetic (60° s^?1) contractions of the knee extensors (range of motion, ROM: 0°–100°, 0 = full extension) using either dominant or non‐dominant leg. They repeated a similar eccentric bout using the contralateral leg 6 weeks later. The sequence of leg's use was allocated to create equally balanced groups. Four indirect markers of muscle damage including subjective pain intensity, maximal isometric strength, muscle stiffness and plasma creatine kinase (CK) activity were measured before and 24 h after exercise. All markers changed significantly following the eccentric bout performed either by dominant or non‐dominant legs, but no significant difference was observed between legs. Interestingly, the comparison between the first and second eccentric bouts revealed that muscle soreness (?42%, P<0·001), CK activity (?62%, P<0·05) and strength loss (?54%, P<0·01) were significantly lower after the second bout. This study suggests that leg dominance does not influence the magnitude of exercise‐induced muscle damage and supports for the first time the existence of a contralateral protection against exercise‐induced muscle damage in the lower limbs.     

Development of a 32-item scale to assess postoperative dysfunction after upper gastrointestinal cancer resection

Aim. The purpose of this study was to develop a 32‐item scale to assess postoperative dysfunction in patients who underwent surgery for gastric and oesophageal cancer and to evaluate its reliability and validity. Background. For the objective assessment of postoperative dysfunction in patients with upper gastointestinal cancer, we performed a preliminary survey by mail using a 34‐item questionnaire as a initial version. The results of the survey were assessed by item analysis of the scale. The scale items were further refined by researchers and specialists, and a 32‐item scale for the assessment of postoperative dysfunction (initial scale) was developed. Methods. Using this 32‐item scale (initial scale), a mail survey was performed of 379 subjects selected by random sampling. Results. The questionnaire was returned by 292 patients (77·1%) and 283 responses (74·7%) were valid. Of these, 221 respondents had gastric cancer and 62 oesophageal cancer. The mean age of respondents was 64·9 SD 9·8 (range 35–89) years. The mean total score of the 32‐items on the initial version for the assessment of postoperative dysfunction was 60·8 SD 16·7. The mean total score for gastric cancer patients and oesophageal cancer patients was 58·1 SD 15·8 and 70·1 SD 16·7 respectively. After the elimination of scale items regarded as irrelevant based on statistical considerations and the judgement of experts, factor analysis was performed. Seven factors were valid: ‘regurgitation reflux’, ‘limited activity because of decreased food consumption’, ‘passage dysfunction immediately after eating’, ‘dumping‐like symptoms’, ‘transfer dysfunction’, ‘hypoglycaemic symptoms’ and ‘diarrhoea‐like symptoms’. The cumulative proportion of variance by scale reliability was confirmed by a Cronbach's α‐coefficient of 0·926. The Cronbach's α‐coefficient for all 32 items on the initial version was 0.926, the Cronbach's α‐coefficient for sub‐items was 0·705–0·856, and Pearson's correlation coefficient of re‐test for the total score of the 32 items was 0·865, which confirmed a high degree of internal consistency. The construct validity of the scale was confirmed using the known‐group technique by operative procedures, and from the result of factorial validity. This scale was named ‘Postoperative Dysfunction for Upper Gastrointestinal Cancer 32; PODUGC‐32’. Conclusion. This scale is sufficiently reliable and valid and will be useful clinically. Relevance to clinical practice. We can use the new scale to assess postoperative dysfunction in patients with upper gastointestinal cancer for nursing practice.     

Comparison of the uncertainty level of radical prostatectomy recipients with or without psychological support

The aim of this study is to measure the levels of uncertainty in radical prostatectomy (RP) recipients who have received psychological support in comparison with those who have not. RP is one of the most effective treatments for prostate cancer, but its complications may cause patients to have a sense of uncertainty. A questionnaire survey was conducted. Participants were recruited from two hospitals. Sixty‐two participants who underwent an RP were recruited to the support group, and 43 participants were included in the non‐support group. The support group of males received psychological support and the control group of males did not receive psychological support. A survey was developed and used to assess each male, at least 3 months after his RP. All subjects participated in the survey and self‐reported using the Chinese version of the Mishel Uncertainty Illness Scale (MUIS). The reliability (α) of the overall MUIS was 0·92 in this study. The mean level of the uncertainty score among the support group was 45·65 (SD = 10·81), and 80·47 (SD = 5·00) among the non‐support group. Two‐way anova showed that psychological support produced a significant effect (F = 197·25, p < 0·001), which indicated that the males in the psychological support group expressed lower levels of uncertainty than males in the non‐support group. The results suggest that offering psychological support is an effective nursing intervention that can decrease the levels of uncertainty in RP recipients. The feeling of uncertainty among post‐RP patients is common. Urological nurses should therefore assume the responsibilities associated with the consequences of prostate cancer treatment, including understanding the treatment's relevant information, seeking appropriate nursing interventions and providing psychological support to decrease the level of uncertainty in RP patients.     

Self‐reported quantity of daily water intake and urine output in healthy young

Water is an essential nutrient and adequate intake and output of water is required for health maintenance. Water homeostasis is vital for life and optimal function and considerable interest surrounds the issue of recommendations for water consumption in healthy individuals. Few studies are available about self‐reported water intake and urine output. The aim of this study was to assess the quantity of water intake and urine output in 24‐h period in healthy young individuals. This prospective study was carried out on 31 students aged 18–24 years undergoing nursing education in a University during January 2011 in Sakarya, Turkey. Healthy young individuals were recruited for determination of the quantity of water taken in and urine excretion along 24 h; they recorded fluid input and urine output. The students collected the data during weekend break. In our study, the total daily fluid intake (mL) for females was 2082·6 ± 687·1 and the total daily fluid intake (mL) for males was 2720·8 ± 717·4. The total daily quantity of urine (mL) for females was 1623·4 ± 602·4 and the total daily quantity of urine (mL) for males was 1818·3 ± 420·6. This research may be the source for similar studies that could include seasonal changes, climates, cultures and different age groups.     

Pharmacokinetics and pharmacodynamics of intravenous dexmedetomidine in healthy Korean subjects

What is known and Objective: Dexmedetomidine is a selective alpha2‐adrenoreceptor agonist used for sedation in critically ill patients. The current study aimed to evaluate the pharmacokinetics (PKs), pharmacodynamics and tolerability of intravenous dexmedetomidine in healthy Korean subjects. Methods: A randomized, double‐blind, placebo‐controlled study with three parallel dosage groups was conducted. Twenty‐four subjects were randomly assigned to placebo or one of three dexmedetomidine dosing regimens, 3 μg/kg/h for 10 min followed by 0·17 μg/kg/h for 50 min (low dose), 6 μg/kg/h for 10 min followed by 0·34 μg/kg/h for 50 min (middle dose) and 3·7 μg/kg/h for 35 min followed by 0·7 μg/kg/h for 25 min (high dose). Serial blood samples for PK analysis were taken up to 12 h. PK parameters were determined using non‐compartmental methods (WinNonlin^®), and a population PK model was developed using nonmem ^®. The sedative effect of dexmedetomidine was assessed by Ramsay sedation score and visual analogue scales/sedation. Adverse events, clinical laboratory tests, electrocardiograms, physical examinations and vital signs were monitored for tolerability assessment. Results: Six subjects were assigned to each of the three active treatment group or placebo group. The AUC_last of the low‐, middle‐ and high‐dose group were 1096·8 ± 119·9 (mean ± SD) ng*h/L, 2643·0 ± 353·2 ng*h/L and 5600·6 ± 411·0 ng*h/L, respectively. PK of dexmedetomidine was best described using a two‐compartment model. The typical value of the population model can be calculated using the following equations: central volume of distribution (L) = 19·9 (age/27)^0·954, peripheral volume of distribution (L) = 59·4, clearance (L/h) = 33·7 (albumin level/4·3)^1·42 and inter‐compartment clearance (L/h) = 67·7. Sedative effects were significantly increased by dexmedetomidine compared to placebo. The blood pressure and heart rate were decreased, but oxygen saturation was maintained stable. What is new and Conclusion: Dexmedetomidine shows linear PK characteristics and dose‐dependent sedative effects. A two‐compartment population PK model was developed for healthy Korean subjects. The PK parameter estimates are similar in Koreans and Caucasians.     

异丙酚在小儿内眼手术麻醉中的应用

目的：比较氯胺酮和异丙酚分别用于小儿内眼手术麻醉的异同点。方法：选择80例小儿择期内眼手术患者.年龄81d～12岁，随机分为氯胺酮＋局麻组和异丙酚＋局麻组。每组40例，观察眼压、循环和术后恢复情况等指标。结果：异丙酚在降低眼压，保持循环系统相对稳定，缩短苏醒时间和减轻术后不良反应等方面均优于氯胺酮。     

The association between allogeneic perioperative blood transfusion on tumour recurrence and survival in patients with advanced ovarian cancer

Objective: To evaluate the association between perioperative blood transfusion on the recurrence and survival of patient with advanced ovarian cancer. Background: Cytoreductive surgery for ovarian cancer can be an extensive procedure often requiring allogeneic blood transfusions. Blood transfusions can have detrimental effects on immune function which can lead to a decrease in the organism ability to detect and destroy metastasis. Methods: The study was a retrospective cohort investigation. Patients with advanced ovarian cancer (stage III) undergoing cytoreductive surgery were stratified by the need for perioperative blood transfusion. Allogeneic transfusions were non‐leucodepleted. Primary outcome included time to recurrence and survival. Data were extracted from the gynaecology oncology database at Northwestern University. Times to event outcomes were evaluated by constructing Kaplan–Meyer curves and Cox regression. Results: The charts of 136 subjects were evaluated. Seventy‐six received blood transfusion. Median [95% confidence interval (CI)] time to recurrence for the non‐transfusion group was longer, i.e. 17 (6–27) months, compared to 11 (8–14) months for the transfused group (P = 0·03). Median (95% CI) survival following surgery was longer in the non‐transfused group, i.e. 58 (43–73) months, compared to 36 (28–44) months for the transfused group (P = 0·04). Cox regression showed that transfused subjects had shorter median times to recurrence and mortality after adjusting for age and tumour grade. Conclusions: There is an association between ovarian cancer recurrence and allogeneic perioperative blood transfusion in patients with advanced ovarian cancer undergoing cytoreductive surgery. These findings may have important implications in the perioperative management of those patients.