Clinical experience with a simple retraction device in single-port laparoscopic cholecystectomy: Technical description and initial results

Abstract

Background: Performing single-port laparoscopic cholecystectomy (SPLC) is challenging as triangulation is limited and the critical view is difficult to obtain. We present our initial experience using a simple retraction device to reduce these problems. Material and methods: In January 2012 a novel lifter was introduced at our department and subsequently used in SPLC for suspension of the gallbladder. Perioperative data were collected prospectively. In addition, all videos were reviewed to assess any adverse events caused by the lifter. Results: Thirty (20 female and 10 male) patients at a median age of 48.4 years (range: 23–83) were operated using this novel retraction device. Median BMI accounted for 26.0 kg/m² (median; range: 14.0–36.9). Retraction of the gallbladder using the lifter was possible in all patients. In four cases (13.3 %) spillage of bile caused by the lifter was recorded. In addition, perforation of the gallbladder was seen once (3.3 %), caused by electrocautery. No inflammation, induration or visible scars were seen in the right upper quadrant at six weeks postoperatively in any patient. Conclusions: Gallbladder retraction in SPLC using this novel device is feasible and safe without leaving any apparent scar. Rate of bile spillage is (at least) comparable to that reported for conventional laparoscopic cholecystectomy.     

Single‐port laparoscopic cholecystectomy: A comparative study in 106 initial cases

Introduction: Laparoscopic cholecystectomy has been the standard of care for gallbladder diseases since the late 1980s. Many surgeons have rapidly adopted single‐port laparoscopic cholecystectomy for gallbladder pathologies. The aim of the present study was to analyze the clinical outcome in initial single‐port laparoscopic cholecystectomy. Methods: Data from 106 consecutive single‐port laparoscopic cholecystectomies between May 2008 and April 2009 were analyzed retrospectively. We divided the patients into two groups – an early group (group I, n=56) and a late group (group II, n=50) – to compare clinical outcomes. During each procedure, only one longitudinal transumbilical incision, 1.5 to 2.0 cm in length, was made to access the abdominal cavity. A multichannel port system was assembled with existing devices. Standard laparoscopic instruments were used to perform each cholecystectomy. Results: Patient demographics did not differ between the two groups. Of the eight cases that were converted to conventional laparoscopic surgery, seven were part of group I (P=0.063). Mean operation time for single‐port laparoscopic cholecystectomy was significantly shorter in group II (58.2 versus 71.6 min, P=0.004). There were two operative complications in group I, which were successfully managed with laparoscopic surgery. There was no statistical difference in occurrence of operative complication and hospital stay between the two groups. Conclusion: Single‐port laparoscopic cholecystectomy can be safely performed for various gallbladder lesions in selected cases, and the operation time improved with accumulation of cases.     

Factors Related to the Sensitivity of Emergency Medical Service Impression of Stroke

Abstract

Objectives. To examine factors related to sensitivity of emergency medical services (EMS) stroke impression. Methods. We reviewed ambulance and hospital records of all patients transported to Long Island College Hospital between January 1, 2009 and January 1, 2011 by the hospital-based EMS with a discharge diagnosis of stroke or a confounding diagnosis, and compared EMS impression to hospital discharge diagnosis. We examined relationships between EMS diagnostic sensitivity and age, gender, ethnicity, NIH Stroke Scale (NIHSS), motor signs, aphasia, neglect, lesion side, circulation, stroke type, EMS provider level, and documented Cincinnati Pre-hospital Stroke Scale (CPSS) with contingency analysis and logistic regression. Results. Stroke was validated in 18% (56/310) of patients and 50% (28/56) of these were missed by EMS. EMS diagnostic sensitivity was 50% (95% CI: 36–64%), and was related to NIHSS quartile (p = 0.014), with higher sensitivities in 2nd (69%; 95% CI: 44–86%) and 3rd (75%; 95% CI: 47–91%) vs. 1st (20%; 95% CI: 7–45%) and 4th (45%; 95% CI: 21–72%) quartiles, motor signs (62 vs. 14%, p = 0.002), and documented CPSS (84 vs. 32%, p = 0.0002). EMS impression was independently related to NIHSS quartile (1st vs. 2nd adjusted OR = 9.61, 1.13–122.03, p = 0.038) and CPSS (adjusted OR = 12.58, 2.22–111.06, p = 0.003). Conclusion. Stroke was missed more frequently when CPSS was not documented, in patients without motor signs, and in patients with moderate–severe stroke. The sensitivity of prehospital screening for patients with moderate–severe stroke might be improved by including additional non-motor signs and by stressing indications for when screens should be performed.     

Transvaginal endoscopic cholecystectomy using a simple magnetic traction system

Abstract

Natural orifice transluminal endoscopic surgery (NOTES) is still at an early stage of clinical development. The development of new instruments is required to overcome some of the current limitations of NOTES. We thus performed transvaginal endoscopic cholecystectomies to determine the feasibility of using a magnetic traction system. Experiments were performed in a non-survival porcine model (n = 4). The magnet-fixed endoscopic clip was attached to the apex of the gallbladder fundus and held together with the external handheld magnet across the abdominal wall. The gallbladder fundus was then retracted to the cephalic direction by moving the external handheld magnet and the gallbladder was dissected from the liver bed. The gallbladder was placed in the endocatch material and delivered through the vagina. NOTES cholecystectomies via the transvaginal approach were successfully performed in a porcine model. The magnetic traction system was effective in achieving adequate exposure in all pigs. The magnetic traction system provides vigorous, multi-axial traction as required for the cholecystectomy procedure. There were no complications during the procedure other than minor bleeding from the liver bed. The mean procedure time was 133.8 minutes (range, 105 to 175 minutes). Our study successfully demonstrated the feasibility of the magnetic traction system in NOTES.     

Sonographic evaluation of diaphragmatic function during breathing control

Objective: To investigate the effect of “breathing control” on sonographic diaphragmatic excursion. Method: A prospective, randomized, assessor-blinded study design involving 20 physiotherapy students; ten with knowledge of the breathing control technique (Group BC) and ten without (Group CON). All participants were asked to perform a Chester step test. Group BC performed BC, while Group CON adopted their own breathing pattern during recovery after the step test. Respiratory rate and sonographic parameters of the diaphragm including diaphragmatic excursion, speed of diaphragmatic contraction (slope of contraction), and inspiratory time were recorded before and after the step test. Results: All baseline data were similar for both groups except age. Respiratory rate at 1 min post-step test was higher in Group CON (24.6±4.9 bpm) compared to Group BC (15.6 ± 3.8 bpm) (p < 0.001). Post-step test sonographic evaluation demonstrated an increase in diaphragmatic excursion with a significant time and group interaction (F_(4,72) = 5.499, p = 0.005). Post hoc analysis revealed that the diaphragmatic excursion was significantly higher in Group BC compared to Group CON at first, second and third minute post-step test. Time and group interactions were not significant in inspiration time (F_(4,72) = 2.459, p = 0.082) nor the slope of contraction (F_(4,72) = 0.655, p = 0.582)]. Conclusion: Post-exercise diaphragmatic excursion was higher in participants applying BC. Non-invasive ultrasonography is able to promote objective evaluation of the relationship between breathing techniques and diaphragmatic function.     

Clinical outcomes from early use of digoxin-specific antibodies versus observation in chronic digoxin poisoning (ATOM-4)

Introduction: In our previous study on chronic digoxin poisoning, there was a minor improvement after treatment with digoxin-specific antibody (digoxin-Fab). We hypothesised patients with elevated digoxin concentrations may derive little benefit from digoxin-Fab because their presenting complaint was more closely related to their multiple co-morbidities. We aimed to compare the outcome of patients who were initially treated with digoxin-Fab with those that received supportive care.

Method: Patients were prospectively recruited to the study if they had an elevated digoxin concentration, signs or symptoms of toxicity thought to be from digoxin. Patients who were initially managed with digoxin-Fab were compared with those not initially receiving digoxin-Fab (observation group). Patients presented with ventricular arrhythmias before initial assessment were excluded from the analysis. Primary outcome was mortality. Secondary outcomes were length of stay (LOS), change in heart rate (HR) and potassium concentration.

Results: From September 2013 to January 2018, 128 patients were recruited of which 78 (61%) received initial digoxin-Fab. Digoxin-Fab and supportive care groups had an initial median heart rate of 46 (range: 20–120) vs 52 bpm (range: 29–91) (p?=?.06), systolic blood pressure of 110?mmHg (range: 65–180) vs 125?mmHg (range: 90–184) (p?=?.009), respectively. Digoxin concentrations 4.4?nmol/L (range: 3.3–9) vs 4.2 (range: 2–11.2) (p?=?.42) and potassium concentrations 5.4?mmol/L (range: 3–11) vs 5.1?mmol/L (range: 3.5–8.2) (p?=?.33) were similar. Median dose of digoxin-Fab used was 1.5 vials (IQR: 1–2). There were 9 (12%) deaths in the Fab group compared to 7 (14%) in those treated with supportive care (risk difference ?2.5%; 95% CI: ?14 to 9%; p?=?.68). The median LOS was six days in both groups. Mean changes in potassium concentration [?0.5?±?0.1 vs. ?0.4?±?0.1?mmol/L; difference ?0.1 (95% CI: ?.02, 0.4), p?=?.70] and HR within 4?h [8?±?1 vs. 7?±?3 bpm; difference ?1.0 (95% CI: ?6.7, 4.8), p?=?0.74] were similar in the two groups.

Conclusions: This study did not appear to show any benefit from the routine use of digoxin-Fab in patients thought to have chronic digoxin poisoning. These patients have multiple co-morbidities that may be contributing to their clinical features, other treatments are often equally effective.     

A Comparison of Three Methods,Utilizing Different Principles,for the Determination of Uric Acid in Biological Fluids

Abstract

Objective: The aim of the study was to compare endocrine parameters such as leptin, visfatin, insulin resistance, exercise capacity and body composition change, the pulmonary functions test (PFT) and arterial blood gases (ABG) parameters of chronic obstructive pulmonary disease (COPD) patients and in healthy controls. Materials and method: Fifty-five patients with COPD and without malnutrition and 25 healthy controls were included in our study. The serum leptin, visfatin, tumor necrosis factor alpha (TNF-α) and insulin resistance, body fat-free mass (FFM) and fat mass (FM) were measured in the groups. Additionally, body mass index (BMI) was calculated and the 6-minute walk test (6MWT), PFT and ABG analyses were performed in all of the cases. Results: No difference in BMI between the COPD group and controls was determined. Serum leptin and visfatin levels, FFM and 6MWT distance were significantly lower in the patients with COPD (p < 0.001, p = 0.001, p = 0.032, p < 0.001, respectively). A correlation was found between serum leptin levels and BMI (r = 0.333, p = 0.027), and with FM (r = 0.365, p = 0.029). Serum visfatin level was correlated with the percentage of forced expiratory volume in the first second in the patients with COPD (r = 0.371, p = 0.013). HOMA-IR (Homeostasis model assessment of insulin resistance) and serum TNF-α levels in the patients with COPD were found to be significantly higher than controls (p = 0.001, p < 0.001). Conclusion: These results may be earlier signs for further diseases that can emerge in the advanced stages in patients with COPD. Evaluating the patients not only with the pulmonary function and also systemically, contributes to minimizing the mortality and morbidity.     

The effect of prehabilitation on the range of motion and functional outcomes in patients following the total knee or hip arthroplasty: A pilot randomized trial

Objective: The study investigated the effect of prehabilitation on the quality of life and function in patients having total knee replacement (TKR)/total hip replacement (THR). Methods: A pilot randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis was conducted. Sixty-four people undergoing elective lower-limb arthroplasty were included. Prehabilitation included one-hour twice-weekly sessions for at least three and a maximum of four weeks prior to surgery. Control participants did not complete any pre-surgical programs. Health utility and quality of life as measured by the EQ-5D-3L and the patient-specific functional scale were the primary outcomes measured before allocation and eight weeks post-operatively. Results: No between-group differences were evident in health utility (main effect of the group ?0.04 (95% Confidence Interval [CI] ?0.16 to 0.08, p = 0.50) or patient-specific functional scale (main effect of the group ?0.59 (95% CI ?1.8 to 0.6, p = 0.73), but the group-by-joint interaction effects for the timed up and go (TUG) (7.6 (95% CI ?0.9 to 16.1, p = 0.08)) and the EQ-5D VAS (?18.3 (95% CI ?41.1 to 4.5), p = 0.11) were larger. Prehabilitation participants’ knee flexion improved by 12.6 degrees (95% CI 5.2–20, p = 0.001). Conclusions: Prehabilitation improved knee flexion, but this did not translate into improved functional mobility or quality of life.     

N-terminal pro brain natriuretic peptide reflects long-term complications in type 1 diabetes

Abstract

Purpose. To evaluate N-terminal pro brain natriuretic peptide (NT-proBNP) as a marker of long-term micro- and macrovascular complications in type 1 diabetes. Methods. This was a cross-sectional study of 208 long-term surviving type 1 diabetic patients from a population-based cohort from Fyn County, Denmark. In a clinical examination in 2007–2008, NT-proBNP was measured and related to proliferative diabetic retinopathy (PDR), nephropathy, neuropathy and macrovascular disease. Results. Median age and duration of diabetes was 58.7 and 43 years, respectively. Median NT-proBNP concentration was 78 pg/ml (10th–90th percentile 25–653 pg/ml). The NT-proBNP level (89 vs. 71 pg/ml, p = 0.02) was higher in women. In univariate analyses, NT-proBNP was associated with age, duration of diabetes, diastolic blood pressure (inversely), nephropathy, neuropathy and macrovascular disease. For instance, median NT-proBNP concentrations were 70, 91 and 486 pg/ml for patients with normo-, micro- and macroalbuminuria, respectively (p < 0.01). When adjusted for age, sex, duration of diabetes, high sensitivity CRP, HbA_1c, diastolic blood pressure and smoking, higher NT-proBNP concentrations (4th vs. 1st quartile) were related to nephropathy (odds ratio [OR] 5.03; 95% confidence interval [CI] 1.77–14.25), neuropathy (OR 4.08; 95% CI 1.52–10.97) and macrovascular disease (OR 5.84; 95% CI 1.65–20.74). There was no association with PDR. Conclusions. NT-proBNP has traditionally been described as a marker of heart failure and left ventricular dysfunction. In this study of long-term surviving type 1 diabetic patients, we found NT-proBNP associated with nephropathy, neuropathy and macrovascular disease. If confirmed by prospective studies, NT-proBNP might be a useful prognostic marker of diabetes-related complications.     

First episode of acute low back pain – an exploratory cluster analysis approach for early detection of unfavorable recovery

Purpose: To identify recovery patterns in patients with a first episode of acute low back pain (LBP) and to define risk factors for unfavorable outcome.

Methods: One hundred and eight patients (55 male, 53 female; mean age?=?40.8, SD 14.2 years) rated pain (NRS) and disability [Oswestry Disability Index (ODI)] before the first treatment and 1 week, 1, 3, 6, and 12 months later. Hierarchical cluster analysis identified recovery patterns based on NRS data. Clusters were compared for age, NRS and ODI at baseline, pain reduction in the first week, gender, radicular signs and traumatic onset using one-way ANOVA (post hoc Bonferroni) and χ² tests.

Results: The cluster analysis revealed four clusters: moderate baseline pain/fast recovery; high baseline pain/fast recovery; high baseline pain/persistent mild pain; high baseline pain/persistent high pain. These clusters differed in baseline NRS [F(3,104)?=?39.61, p?F(3,104)?=?12.17, p?F(3,104)?=?11.51, p?χ²(3)?=?9.20, p?=?0.027].

Conclusions: These results suggest that an initial and regularly repeated assessment of pain intensity and functional disability is important. Initial pain intensity does not seem to be a prognostic factor per se, as it did not negatively affect recovery provided that it decreased early in treatment.

• Implications for Rehabilitation

• Prediction of outcome is particularly important in patients with a first episode of acute LBP as one third did not completely recover.

• Pain intensity and functional disability should be initially assessed and regularly repeated in the first phase of treatment.

• High initial pain intensity and disability combined with small pain reduction during the first week might predict unfavorable outcome and require adequate treatment.

     

Laser-assisted fixation of intimal edges

Abstract

Introduction: Although the retroperitoneal approach has been the preferred choice for open urological procedures, retroperitoneoscopy is not the preferred approach for laparoscopy. This study aims to develop a training model for retroperitoneoscopy and to establish an experimental learning curve. Material and methods: Fifteen piglets were operated on to develop a standard retroperitoneoscopic nephrectomy (RPN) training model. All procedures were performed with three ports. Intraoperative data (side, operative time, blood loss, peritoneal opening) were recorded. Animals were divided into groups A, the first eight, and B, the last seven cases. Data were statistically analyzed. Results: We performed fifteen RPNs. The operative time varied from 15 to 50 minutes (median 30 minutes). Blood loss varied from 5 to 100 mL (median 20 mL). We experienced five peritoneal openings; we had two surgical vascular complications managed laparoscopically. There was statistical difference between groups A and B for peritoneal opening (p = 0.025), operative time (p = 0.0037), and blood loss (p = 0.026). Discussion: RPN in a porcine model could simulate the whole procedure, from creating the space to nephrectomy completion. Experimental learning curve was eight cases, after statistical data analysis. Conclusion: RPN in a porcine model is feasible and could be very useful for teaching and practicing retroperitoneoscopy.     

Compensated hepatitis C: unenhanced MR imaging correlated with pathologic grading and staging

Abstract Background We prospectively examined unenhanced MR imaging findings in relation to pathologic fibrosis, inflammation and steatosis in patients with compensated chronic hepatitis C viral infection (HCV). Methods Unenhanced MRI at 1.5 T was obtained within one month of core liver biopsy in 64 consecutive candidates for antiviral therapy for compensated HCV. Two pathologists independently graded inflammatory activity index (HAI) and steatosis, and staged fibrosis (grades 0–6). Morphologic MRI findings of cirrhosis, periportal lymph nodes, and MR fat signal ratio from dual gradient echo images were assessed independently by two radiologists blinded to clinical data. MRI and laboratory liver function results were correlated with pathologic results, using Spearman correlation coefficient and stepwise multiple regression. Results MR fat signal ratio correlation coefficient with pathologic steatosis was 0.71 (p < 0.0001). Coefficients with fibrosis stage were highest for surface nodularity (r _s = 47, p < 0.0001) and expanded gallbladder fossa (r _s = 0.42, p = 0.0006). Coefficients with HAI were highest for lymph node size (r _s = 0.355, p = 0.0040), surface nodularity (r = 0.47, p < 0.0001), expanded gallbladder fossa (r = 0.332, p = 0.0073), and caudate/right lobe ratio (r = 0.326, p = 0.0110). Combined lab and MRI variables provided the best prediction of fibrosis stage (r ² = 0.656) and HAI (r ² = 0.597). Conclusions A combination of MRI and laboratory findings was most predictive of fibrosis and inflammation.     

Salbutamol in acute organophosphorus insecticide poisoning – a pilotdose-response phase II study

Background: Treatment of acute organophosphorus (OP) insecticide poisoning is difficult, with many patients dying despite best care. Pre-clinical studies have shown benefit from salbutamol, possibly due speeding alveolar fluid clearance or reducing bronchoconstriction. In this small pilot dose-response study, we aimed to explore whether addition of nebulized salbutamol to standard care might improve resuscitation.

Methods: We performed a single-blind phase II study comparing the effect of two different doses of nebulized salbutamol versus saline placebo, in addition to standard treatment. Primary outcome was oxygen saturations over the first 60?min of resuscitation; secondary outcomes included heart rate, incidence of dysrhythmias, time to ‘atropinization’, atropine dose required, and mortality.

Result: Seventy-five patients were randomized to receive 5?mg (Salb5, n?=?25) or 2.5mg (Salb2.5, n?=?25) of salbutamol, or saline placebo (NoSalb, n?=?25), by nebulizer. Oxygen saturations did not differ between groups over the first 60?min of resuscitation (median AUC NoSalb: 1376 [95% CI 1282 to 1470], Salb2.5: 1395 [1305 to 1486], Salb5: 1233 [1100 to 1367]; p?=?.9898). Heart rate was also similar across the three arms. Median time to full atropinization, and atropine dose required, were the same for all three arms (NoSalb 15.0 [10–16] min and 12.6 [8.0–13.4] mg, Salb2.5 15.0 [10–16] min and 12.6 [9.3–16.8] mg, and Salb5 15.0 [10–20] min and 12.6 [10.7–20.6] mg; p?=?.4805 and p?=?.1871, respectively). Three (12%) patients died in the Salb2.5 and Salb5 groups and two (8%) in the NoSalb group.

Conclusion: This pilot study, within the limitations of its small size and variation between patients, found no apparent evidence that administration of nebulized salbutamol improved resuscitation of patients with acute OP insecticide self-poisoning. The data obtained provides a basis to design further studies to ultimately test the role of salbutamol in OP insecticide poisoning.     

Two-year follow-up of outcomes related to scarring and distress in children with severe burns

Purpose: We assessed the perception of scarring and distress by pediatric burn survivors with burns covering more than one-third of total body surface area (TBSA) for up to 2 years post-burn.

Methods: Children with severe burns were admitted to our hospital between 2004 and 2012, and consented to this IRB-approved-study. Subjects completed at least one Scars Problems and/or Distress questionnaire between discharge and 24 months post burn. Outcomes were modeled with generalized estimating equations or using mixed linear models. Significance was accepted at p?Results: Responses of 167 children with a mean age of 7?±?5 years and burns covering an average 54?±?14% of TBSA were analyzed. Significant improvements over the 2-year period were seen in reduction of pain, itching, sleeping disturbance, tightness, range of motion, and strength (p?p?Conclusions: According to self-assessment questionnaires, severely burned children exhibit significant improvements in their overall perception of scarring and distress. However, these patients remain self-conscious with respect to their body image even 2 years after burn injury.

• Implications for Rehabilitation

• According to self-assessment questionnaires, severely burned children perceive significant improvements in scarring and distress during the first 2 years post burn. Significant improvements were seen in reduction of pain, itching, sleeping disturbances, tightness, range of motion, and strength (p?

• Burn care providers should improve the treatment of burns surrounding the mouth that with result in scarring, and develop strategies to prevent skin discoloration. Careful evaluation of pain and sleeping disorders during the first year post burn are warranted to improve the patient rehabilitation.

• Overall, significantly more female patients expressed a persistent desire to hide their scarred body areas. The rehabilitation team should provide access to wigs or other aids to pediatric burn survivors to address these needs.

     

Early age at menarche is associated with insulin resistance: a systemic review and meta-analysis

Objectives: We aimed to conduct a systemic review and meta-analysis of the relevant studies to further investigate the association between age at menarche and insulin resistance.

Methods: PubMed, EMBASE, and Web of Science (SCI) databases were systemically searched until December 2017. Observational studies comparing the incidences of insulin resistance in patients with early, average, and late menarchal ages were identified. Weighted mean difference (WMD) for HOMA-IR scores and fasting serum insulin levels in early vs late, early vs average. and average vs late comparisons were calculated with a random- or fixed-effects model.

Results: A total of eight articles involving 5504 subjects were finally included. In the analysis of HOMA-IR, the pooled WMDs in five studies were 0.45 (95% confidence interval [CI] 0.31–0.60, p < 0.001), 0.40 (95% CI 0.28–0.52, p < 0.001), and ?0.01 (95% CI ?0.09 to 0.07, p = 0.854) for early vs late, early vs average, and average vs late comparisons, respectively. The fasting serum insulin levels in eight studies were analyzed, and it was significantly higher in subjects with earlier age at menarche (WMD 1.28, 95% CI 0.92–1.63, p < 0.001 for early vs late comparison, WMD 1.28, 95% CI 1.13–1.43, p < 0.001 for early vs average comparison) with mild and acceptable heterogeneity (I² = 42.5% and 7.4%, respectively). Publication bias was not detected via funnel plots and Egger’s tests.

Conclusions: Our study revealed that earlier age at menarche was significantly associated with insulin resistance.

Trial Registration Number: CRD42018083874     

Effectiveness of lavender inhalation aromatherapy on pain level and vital signs in children with burns: a randomized controlled trial

BackgroundBurns are a source of pain, which cannot be fully treated with medications.ObjectivesThis study aims is to test the effectiveness of lavender oil inhalation aromatherapy applied before dressing change on vital signs and pain levels of children with burns.DesignThis randomized controlled study was held between May 2018 and May 2019. A total of 108 children who met the inclusion criteria were studied in three groups: Lavender-15 Group inhaled lavender oil for 15 min before dressing (n:36), Lavender-60 Group inhaled lavender oil for 60 min before dressing (n:36), and Control Group inhaled jojoba (placebo) oil for 15 min before dressing (n:36). Baseline pain levels and vital signs of the children were measured before inhalation. Pain levels and vital signs of the children were re-measured at the 1st and 30th minutes after dressing.ResultsThere was no significant difference between the groups in terms of pain levels (p = 0.750) and vital signs before dressing. In post-dressing measurements, the number of respiration (after 1 min p = 0.000, after 30 min p = 0.000), heart rate (after 1 min p = 0.000, after 30 min p = 0.000), mean arterial blood pressure (after 1 min p = 0.010, after 30 min p = 0.000) and pain levels (after 1 min p = 0.000, after 30 min p = 0.000) were lower in the Lavender groups compared to the placebo group.DiscussionThe result of this research reveals that inhalation aromatherapy which applied before dressing in children with burns affects the reduction of pain levels and stabilization of vital signs.     

Accuracy of N‐terminal‐pro‐atrial natriuretic peptide in patients admitted to emergency department

Objective. B‐type natriuretic peptide (BNP) and N‐terminal‐pro‐BNP (Nt‐proBNP) are commonly used for the triage of patients in the emergency department (ED) with dyspnoea and/or chest pain. The aim of our study was to determine the accuracy of N‐terminal‐pro‐ANP (Nt‐proANP) in such patients. Material and methods. Nt‐proANP was measured by home‐made radioimmunoassay in 137 ED patients admitted with cardiovascular and/or pulmonary disorders. BNP and Nt‐pro‐BNP were determined with automated assays. Final diagnosis was confirmed at discharge or after follow‐up. Results. Nt‐proANP levels were significantly influenced by the diagnostic subgroups (ANOVA: p<0.001) and were [geometric mean (range)]: 19727?ng/L (5260–45200) in congestive heart failure (CHF, n = 31), 6575?ng/L (1350–36000) in coronary artery disease (CAD, n = 19), 5324?ng/L (1710–13150) in pulmonary embolism (PE, n = 20), 5035?ng/L (1510–16600) in pulmonary diseases (PD, n = 24) and 3001?ng/L (750–11860) in patients without cardiopulmonary diseases (n = 43). Pairwise comparisons demonstrated that CHF patients had Nt‐pro‐ANP values higher than all other groups (p<0.05) and that patients without cardiopulmonary diseases had the lowest values (p<0.05). For diagnosis of CHF, the area under the ROC curve of Nt‐proANP was 0.94 (95?% CI: 0.89–0.98) and was equivalent to Nt‐proBNP (0.91; p = 0.284) and BNP (0.93; p = 0.572). Conclusions. The diagnostic accuracy of Nt‐proANP was equivalent to BNP and Nt‐proBNP in the present cohort of patients admitted to ED with dyspnoea and/or chest pain.     

Impact of atrial fibrillation on levels of high-sensitivity troponin I in a 75-year-old population

Abstract

Purpose. Atrial fibrillation (AF) has been associated with elevated levels of cardiac troponins; however, it is not clear if this association is independent of underlying cardiovascular disease. The aim of this study was to investigate the impact of AF on cardiac troponin I levels in a 75-year-old cohort from the general population, using a recently introduced, highly sensitive assay. Methods. All 75-year-old citizens in Asker and Baerum counties were invited to participate in a prevalence study of AF. High-sensitive troponin I (hs-TnI) levels were measured (Abbott Diagnostics) in serum samples collected from 62 subjects with AF and a gender-matched control group of 126 subjects in sinus rhythm. Results. Hs-TnI was detectable in all subjects (median 7.3 ng/L [range 3.0–88.7]). Patients with AF had higher levels than subjects in sinus rhythm (8.3 ng/L [3.7–88.7] vs. 6.8 ng/L [3.0–77.5]; p = 0.011). Male gender (p = 0.002), hypertension (p = 0.001), coronary heart disease (p < 0.001), heart failure (p < 0.001), prior stroke or transient ischemic attack (p = 0.013) and serum creatinine (p < 0.001) were all associated with higher levels of hs-TnI in univariate analysis. Heart failure and coronary heart disease remained significantly associated with hs-TnI in multivariate analysis, whereas the relation between AF and hs-TnI was no longer statistically significant. Conclusion. All subjects had detectable levels of hs-TnI. AF patients had higher hs-TnI levels than subjects in sinus rhythm; however, this difference was not statistically significant after adjustment for heart failure and coronary heart disease.     

Implementation of a reformulated Roche® bilirubin Gen.3 reagent did not affect the relationship between BiliChek transcutaneous and Roche total serum bilirubin

ObjectiveDetermine whether introduction of a reformulated bilirubin reagent, the Roche bilirubin Gen.3 assay, changed the relationship between BiliChek transcutaneous bilirubin (TcB) and total serum bilirubin (TSB).Design and methodsTcB results from term infants in the level 1 nursery obtained within one hour of a TSB were reviewed over two periods, six months before and after the conversion from the previous generation Roche bilirubin reagent to the new Roche Gen.3 bilirubin assay. TcB measurements were performed using BiliChek transcutaneous devices (Respironics, Marietta GA). Distribution of TSB results, and TcB minus TSB bias, were compared before and after introduction of the reformulated Roche bilirubin Gen.3 assay. Median and interquartile range (IQR) TSB values and bias were calculated. A statistical difference between median TSB values and bias were assessed using Man-Whitney test.ResultsA total of 301 paired TcB and TSB results were obtained, 172 before and 129 after implementation of the reformulated Roche bilirubin Gen.3 reagent. Median (IQR) TSB was 7.8 (6.8–8.7)mg/dL (133.3 (116.3–148.8) μmol/L) before and 7.6 (6.7–8.4)mg/dL (130 (114.6–143.6)μmol/L) after implementation of the reformulated reagent (p = .1373). Median (IQR) bias between TcB and TSB was 2.9 (2.2–3.7) mg/dL (49.6 (37.6–63.3)μmol/L) before the reformulated reagent was implemented; and did not change at 2.9 (2.1–3.9) mg/dL (49.6 (35.9–66.7)μmol/L) after implementation (p = .8242).ConclusionImplementation of the reformulated Roche bilirubin Gen.3 reagent did not affect the relationship between BiliChek transcutaneous and total serum bilirubin; thus no changes were needed to the neonatal TcB screening protocol as a result of the new bilirubin reagent.     

Effect of regional fat loss assessed by DXA on insulin resistance and dyslipidaemia in obese women

Abstract

Objective. To investigate the impact of reduction in total fat mass (FM) and regional FMs on indices of insulin resistance and dyslipidaemia in obese women (BMI > 30 kg/m²) after a 1-year weight loss (WL) program; and, secondly, to investigate the potential predictive effect of baseline insulin resistance on reduction in total and regional FMs. Material and methods. In 35 women with > 4kg weight loss, body composition by DXA (dual X-ray absorptiometry), fasting insulin, C-Peptide, insulin resistance (HOMA-IR), insulin sensitivity (QUICKI), metabolic clearance rate (MCRestOGTT) and serum lipids were assessed. Results. Mean WL was 9.6%; trunk and leg FM were reduced proportionally (14.9–14.7%). Improvement in HOMA-IR was 34.7%, insulin 30.7%, QUICKI 8.6% and MCRest OGTT 74%. The reduction in total, trunk and leg FM were similarly correlated with improvement in indices of insulin resistance (p < 0.001–0.05) and also with initial HOMA-IR (p = 0.000–0.02). In linear regressions improvement in HOMA-IR was similarly related with these FMs (p = 0.008), and initial HOMA predicted loss of trunk FM (p = 0.01). In multivariate analysis improvement in HOMA-IR was explained by loss of total FM (R² = 0.20, p = 0.004); improvement of QUICKI by loss of leg FM (R² = 0.33, p < 0.001). Conclusion. Loss of leg FM and trunk FM had similar importance for the improvement in insulin resistance. Baseline HOMA-IR predicted the potential for reduction in trunk FM.