Does the covering of children during induction of anesthesia have an effect on body temperature at the end of surgery?

Study ObjectivesTo determine whether the covering of healthy children during anesthetic induction reduces hypothermia at the end of minor surgeries.DesignRandomized, single-blinded, prospective study.SettingOperating room and postoperative recovery area of a university-affiliated hospital.Patients50 ASA physical status 1 patients, aged 6 months to 3.5 years, scheduled for simple urological surgeries.InterventionsSubjects were randomly assigned to one of two groups: covered or uncovered. Children in the covered group (Group C) were actively warmed on arrival in the operating room (OR) using cotton blankets and a warm forced-air blanket set at 43°C. Children in the uncovered group (Group U) remained uncovered during the induction of general anesthesia. Children in both groups were actively warmed following placement of surgical drapes.MeasurementsTemperature (in Celsius) during the study procedure was recorded for each patient.Main ResultsMean core body temperature at the end of induction did not differ in the two groups, 36.4°C in Group C and 36.6°C in Group U. Mean core body temperature at the end of surgery did not differ between the two groups: 36.9°C in Group C and 37.0°C in Group U.ConclusionLeaving healthy children uncovered during induction of general anesthesia does not have a clinically significant effect on core temperature at the end of induction or of surgery.     

Molecular weight of hydroxyethyl starch: is there an effect on blood coagulation and pharmacokinetics?

Background. The development of hydroxyethyl starches (HES) withlow impact on blood coagulation but higher volume effect comparedwith the currently used HES solutions is of clinical interest.We hypothesized that high molecular weight, low-substitutedHES might possess these properties. Methods. Thirty pigs were infused with three different HES solutions(20 ml kg^–1) with the same degree of molar substitution(0.42) but different molecular weights (130, 500 and 900 kDa).Serial blood samples were taken over 24 h and blood coagulationwas assessed by Thromboelastograph® analysis and analysisof plasma coagulation. In addition, plasma concentration andin vivo molecular weight were determined and pharmacokineticdata were computed based on a two-compartment model. Results. Thromboelastograph analysis and plasma coagulationtests did not reveal a more pronounced alteration of blood coagulationwith HES 500 and HES 900 compared with HES 130. In contrast,HES 500 and HES 900 had a greater area under the plasma concentration–timecurve [1542 (142) g min litre^–1, P<0.001, 1701 (321)g min litre^–1, P<0.001] than HES 130 [1156 (223) gmin litre^–1] and alpha half life (     

Is recall of dreaming during anesthesia a sign of occurrence of postoperative nausea and vomiting?

We examined the relationships between recall of dreaming during anesthesia and postoperative nausea and vomiting (PONV). We found a relationship between PONV within 24 h and age <50 years, use of postoperative epidural analgesia with morphine, and female gender. We also found a relationship between PONV lasting more than 24 h and dream recall. As serotonin plays an important role for both inducing PONV and dream recall, results of the present study may suggest a possible relationship between dream recall and PONV.     

Fracture risk is decreased in acromegaly—a potential beneficial effect of growth hormone

Growth hormone (GH) is an anabolic hormone that may increase bone density and thus decrease fracture risk. Patients with acromegaly have an excess of GH, and we therefore investigated whether fracture risk was decreased in patients with acromegaly. We identified 206 patients newly diagnosed with acromegaly between 1983 and 1996 who underwent pituitary surgery. Each patient was compared with three age- and gender-matched controls randomly selected from the background population. Mean age at diagnosis was 46.0±12.6 years and 50% were women. Before diagnosis, six patients sustained six fractures during 2128 person years and after diagnosis six patients had ten fractures during 1282 years of follow-up. Among the controls, the corresponding figures were 23 subjects with 44 fractures during 6357 years of follow-up before diagnosis and 46 fractures in 28 subjects during 4051 person years. The fracture rate was significantly decreased before (incidence rate ratio: IRR=0.41, 95% CI: 0.18–0.93) but not after the diagnosis (IRR=0.69, 95% CI: 0.35–1.36) of acromegaly was made. Twenty-three patients had undergone measurements of bone mineral density by DXA after diagnosis, and their mean±SD Z-scores both in the lumbar spine (0.92±1.38) and femoral neck (0.54±1.02) were significantly higher than expected. A fracture before diagnosis was a significant risk factor for sustaining an incident fracture after diagnosis (RR=11.8, 95% CI: 4.7–29.3). In conclusion, fracture risk is significantly decreased in patients with acromegaly compared to controls probably due to an anabolic effect of growth hormone on bone.     

Pretreatment effect of adenosine on activation of NF—κB and level of TNF—α during myocardial ischemia and reperfusion in rats

Ithasbeenshownthatischemiaandreperfusion(I/R)increasecytokinelevelsincludingTNF α ,IL 1,IL 6 ,IL 8,IF γ ,andintercellularadhesionmolecule 1(ICAM 1)inthemyocardium .1TNF αandIL 6arethoughttobeimportantintheprogressionofmyocardialdysfunction .2 AdenosineinhibitsmyocardialTNF αproductionin postischenmicrat ,reduceshumanmyocardialinjuryafterI/R ,3anddecreasesLipopolysaccharide (LPS )inducedcardiacandmacrophageTNF a production .4 However ,themolecularmechanismsofadenosineinthedown …     

Stroke volume-directed administration of hydroxyethyl starch (HES 130/0.4) and Ringer’s acetate in prone position during neurosurgery: a randomized controlled trial

Purpose

General anesthesia in the prone position is associated with hypotension. We studied stroke volume (SV)-directed administration of hydroxyethyl starch (HES 130 kDa/0.4) and Ringer’s acetate (RAC) in neurosurgical patients operated on in a prone position to determine the volumes required for stable hemodynamics and possible coagulatory effects.

Methods

Thirty elective neurosurgical patients received either HES (n = 15) or RAC (n = 15). Before positioning, SV measured by arterial pressure waveform analysis was maximized by fluid boluses until SV did not increase more than 10 %. SV was maintained by repeated administration of fluid. RAC 3 ml/kg/h was infused in both groups. Thromboelastometry assessed coagulation. Mann–Whitney U test, Wilcoxon signed-rank test, ANOVA on ranks, and a linear mixed model were applied.

Results

Comparable hemodynamics were achieved with the mean cumulative (SD) boluses of HES or RAC 240 (51) or 267 (62) ml (P = 0.207) before positioning, 340 (124) or 453 (160) ml (P = 0.039) 30 min after positioning, and 440 (229) or 653 (368) ml at the end of surgery (P = 0.067). The mean dose of basal RAC infusion was 813 (235) and 868 (354) ml (P = 0.620) in the HES and RAC group, respectively. Formation and maximum strength of the fibrin clot were decreased in the HES group. Intraoperative blood loss was comparable between groups (P = 0.861).

Conclusion

The amount of RAC needed in the prone position was 25 % greater. The cumulative dose of 440 ml HES induced a slight disturbance in fibrin formation and clot strength. We suggest cautious administration of HES during neurosurgery.     

The effect of LED on blood microcirculation during chronic wound healing in diabetic and non-diabetic patients—a prospective,double-blind randomized study

Chronic wounds, especially in diabetic patients, represent a challenging health issue. Since standard treatment protocols often do not provide satisfactory results, additional treatment methods—like phototherapy using low-level light therapy—are being investigated. The aim of our study was to evaluate the effect of phototherapy with light-emitting diodes on chronic wound treatment in diabetic and non-diabetic patients. Since a sufficient blood supply is mandatory for wound healing, the evaluation of microcirculation in the healthy skin at a wound’s edge was the main outcome measure. Forty non-diabetic patients and 39 diabetics with lower limb chronic wounds who were referred to the University Medical Center Ljubljana between October 2012 and June 2014 were randomized to the treated and control groups. The treated group received phototherapy with LED 2.4 J/cm² (wavelengths 625, 660, 850 nm) three times a week for 8 weeks, and the control group received phototherapy with broadband 580–900 nm and power density 0.72 J/cm². Microcirculation was measured using laser Doppler. A significant increase in blood flow was noted in the treated group of diabetic and non-diabetic patients (p?=?0.040 and p?=?0.033), while there was no difference in the control groups. Additional Falanga wound bed score evaluation showed a significant improvement in both treated groups as compared to the control group. According to our results, phototherapy with LED was shown to be an effective additional treatment method for chronic wounds in diabetic and non-diabetic patients.     

Does cyclosporine have a beneficial effect on the course of chronic hepatitis C infection after renal transplantation?

The aim of our study was to assess the long-term liver histology in renal transplant patients infected with hepatitis C virus (HCV) who were treated with a cyclosporine-based regimen. Among 55 anti-HCV+/RNA+ patients, liver biopsies (LB) were requested every 3 to 4 years after transplantation: two LBs (n=55); three LBs (n=44); four LBs (n=10). Overall, the rate of liver fibrosis progression was 0.07+/-0.03 Metavir U/y. Only three patients out of 55 (5.4%) developed cirrhosis. Liver fibrosis remained stable throughout follow-up in 21 patients; increased in 21 patients; and improved in the remaining 13 patients. The incidence of posttransplant diabetes mellitus was low (9%). We concluded that HCV infection is not harmful to liver histology in more than 50% of renal transplant patients with grafts functioning more than 6 years. Cyclosporine might have beneficial effects on the natural course of HCV infection after renal transplantation.     

Presence of detrusor muscle in bladder tumor specimens—predictors and effect on outcome as a measure of resection quality

ObjectivesTo identify predictors of the absence of detrusor muscle in bladder tumor specimens and analyze its effect on clinical outcome as an indicator of resection quality.MethodsThe bladder cancer database of a tertiary medical center was queried for patients who underwent complete transurethral resection of bladder tumor (TURBT) between 2008 and 2009. Study end points were absence of detrusor muscle in the surgical specimen and its association with disease recurrence/progression.ResultsDetrusor muscle in the surgical specimen was found in 265 of the 332 study patients (79%). The likelihood of finding muscle increased with higher clinical stage (Odds Ratio [OR]-1.8), higher tumor grade (OR-3), larger tumor size (OR-3.2), multifocal disease (OR-1.7), and nonpapillary morphology (OR-2.3). History of bladder cancer, surgeon's experience, and tumor location in the bladder had no effect. In the whole study population, neither tumor recurrence nor disease progression was associated with absence of detrusor muscle. In patients with T1 tumors, absence of detrusor muscle in the specimen was associated with higher early recurrence rate but not worse long-term outcome.ConclusionsAbsence of detrusor muscle in TURBT specimens is not determined by the technical difficulty of the procedure or surgical experience. Surgeons are more prone to obtain deep muscle in large, nonpapillary-appearing tumors, likely reflecting efforts to attain accurate staging in these cases. The presence or absence of detrusor muscle may serve as a surrogate of resection quality in patients with T1 tumors, but its general applicability to the overall population of patients undergoing TURBT remains questionable.     

Efficacy and Safety of a Single Intra-articular Injection of Platelet-rich Plasma on Pain and Physical Function in Patients With Ankle Osteoarthritis—A Prospective Study

Ankle osteoarthritis (OA) can cause disabling symptoms, and some patients prefer to be treated with minimally invasive procedures. The aim was to evaluate the efficacy and safety of a single intraarticular injection of platelet-rich plasma (PRP) for patients with ankle OA. In a prospective study done in a university-affiliated tertiary care medical center, 44 patients with symptomatic ankle OA for at least 6 months were recruited. Patients received a single injection of PRP (3 mL) into symptomatic ankles. The primary outcome was the change from baseline in the visual analog scale (VAS) pain (0-10 cm) at 6 months. Secondary outcomes included the Ankle Osteoarthritis Scale (AOS) score, American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle score, single-leg stance test (SLS), rescue analgesics consumption and patient satisfaction. Thirty-nine participants (88.64%) completed the study. Significantly improvement in the VAS and AOS was noted at 1-, 3-, and 6-month follow-ups (p < .001). The mean VAS pain decreased significantly from 4.1 ± 1.7 at baseline to 2.2 ± 1.9, 1.7 ± 1.5, and 1.8 ± 1.6 at 1, 3, and 6 months (p < .001). The mean total AOS score reduced by 1.5, 2.2, and 2.1 from baseline respectively postinjection (p < .001). The mean AOFAS hindfoot-ankle score improved from 80.3 points at baseline to 87.2, 91.6, and 89.7 points at 1, 3, and 6 months (p < .001). SLS tests improved significantly (p < .001) at each follow-up. Acetaminophen consumption dropped significantly (p < .001) and no serious adverse events occurred. The study showed promise for a single intraarticular injection of PRP in the treatment of ankle OA.     

The effect of exercise on pQCT parameters of bone structure and strength in postmenopausal women—a systematic review and meta-analysis of randomized controlled trials

Summary  

Inconsistent study findings of exercise on areal bone density highlight the need to include parameters of bone geometry and volumetric bone density measurements. Using a systematic review and meta-analysis, we found a decrease in bone loss through the maintenance of cortical and trabecular volumetric bone mineral density (BMD). Studies with longer exercise durations and larger sample sizes are needed.     

Combined effect of DHA and α-tocopherol supplementation during bull semen cryopreservation on sperm characteristics and fatty acid composition

The aim of this study was to investigate the effect of adding n-3 fatty acids (FA) and α-tocopherol (VE) to semen extender on freezing ability and FA composition of bull sperm. Semen was collected from 10 Iranian Holstein bulls and was pooled. In the first experiment, semen was divided into 12 groups including 4 levels of n-3 FA (0, 0.1, 1, 10 ng ml(-1) ) and 3 levels of VE (0, 0.1, 0.2 mmol). The treatment of 0.2 mmol VE and 10 ng ml(-1) n-3 FA had the best post-thawed sperm characteristics (P < 0.01). In the second experiment, lipid composition of the latest treatment and control (without FA and VE) was determined. Adding n-3 FA increased docosahexaenoic acid (DHA) percentage before freezing and after thawing. The ratio of n-3 to n-6 before freezing was higher (P < 0.05) in treated group than in control, and this ratio in the fresh sperm was greater than in the post-thawed sperm (P = 0.1). Results suggested that adding DHA accompanied with an antioxidant to an extender could improve cryosurvival of bull sperm via altering membrane lipid composition.     

What is the effect of overactive bladder symptoms on woman's quality of life during and after first pregnancy?

OBJECTIVE

To evaluate the effect of overactive bladder symptoms (OAB) on women's quality of life (QoL) during and after the first pregnancy, using self‐reported symptom‐based QoL questionnaires.

PATIENTS AND METHODS

In a prospective cohort study, 474 women were asked to complete four self‐reported questionnaires. Urogenital symptoms were assessed with the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). A women was considered to experience ‘dry’ OAB if she replied positively to the following two questions: ‘do you experience a strong feeling of urgency to empty your bladder?’; and ‘do you experience frequent urination?’. A women was considered to experience ‘wet’ OAB if she replied positively to all of the following questions: ‘do you experience a strong feeling of urgency to empty your bladder?’; ‘do you experience frequent urination?’; and ‘do you experience urine leakage related to the feeling of urgency?’.

RESULTS

In all, 344 (72.6%) women who returned all four questionnaires were included in the analysis. After first childbirth there was a rapid decline in the prevalence of dry OAB (45.2% to 7.9%, P < 0.001). In pregnancy the prevalence of wet OAB increased significantly, but a year after childbirth the prevalence of wet OAB decreased and was similar to that at 12 weeks of gestation (P = 0.289). Women with wet OAB had higher scores on all IIQ domains than those with no OAB symptoms at 36 weeks of gestation. Women with dry or wet OAB all had higher scores on the mobility domain than those with no OAB. The scores on the physical, social and emotional functioning domains were low, suggesting a minimal restriction of lifestyle.

CONCLUSION

OAB symptoms are common during pregnancy; dry OAB had no negative effect on QoL, whereas wet OAB compromised QoL both during and after pregnancy, mainly in the ‘mobility’ and ‘embarrassment’ domains. The urge urinary incontinence symptom in wet OAB seems to profoundly compromise QoL. Apparently, in young mothers with wet OAB, limitations in mobility are especially stressful and these symptoms can be embarrassing.

     

The effect of a controlled mandible position mouthguard on upper body strength and power in trained rugby athletes – A randomized within subject study

BackgroundIt is widely accepted that mouthguards are effective for injury protection in sports. However, findings on the effects of mouthguards in strength and power production remains controversial. Therefore, the aim of this study was to determine whether controlled-mandible position mouthguards influence strength and power production in well trained athletes.MethodsTwenty-two male amateur rugby players (25 ± 3.84 yrs; 1.92 ± 0.07 m; 93.91 ± 11.99 kg) volunteered for this study. Every participant performed an 1RM bench press test (113.20 ± 16.83 kg) to determine his maximal strength. In a randomized order, a ballistic bench press using 40% of the obtained 1RM (44.93 ± 6.76 Kg) was performed in a guided bar attached to a linear position transducer (LPT) for the following conditions: a) no mouthguard (CON); b) controlled mouthguard (MCM - jaw in centric relation); c) non-controlled mouthguard (NCM) and d) occlusal splint (OS). Vertical dimension of occlusion was also assessed for each of the testing conditions.ResultsAthletes using a controlled mouthguard demonstrate a significant (p < 0.05) higher peak acceleration and peak force than those using no mouthguard. Additionally, when analysing the results of vertical dimension of occlusion, a significant difference (p < 0.05) was observed between controlled mouthguard and the other tested conditions.ConclusionControlled mouthguards enhance peak force and peak acceleration in the ballistic bench press exercise without negatively affecting any other measure assessed in this study. We speculate that this is possibly due to an increased stability of temporomandibular joint.     

Assessment of gastrointestinal function and its’ effect on bone mineral density and body composition in hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome

BackgroundHypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are associated with hypermobility, musculoskeletal pain, a decreased bone mineral density (BMD) and gastrointestinal (GI) complications. The role of GI symptoms and diet in BMD has not been established in this population. The GI complications can lead to an energy deficit due to lack of essential macronutrients. The primary objective of this study was to determine the severity of GI symptoms compared to body composition and BMD in individuals with hEDS/HSD. The secondary objective is to examine GI symptoms on energy balance, body composition and strength.MethodologyThis study was IRB approved. Eighteen female participants (aged 28.2 ± 4.9; BMI 22.5 ± 4.9) with a diagnosis of hEDS or HSD and 18 female healthy control participants (aged 28.1 ± 3.8; BMI 22.8 ±3.9) signed consent to participate. Participants were matched by sex, age, and BMI. The Gastrointestinal Symptom Rating Scale (GSRS) was used to investigate severity of GI symptoms. Dual X-ray absorptiometry was used to determine body composition (body fat%, lean body mass (LBM). BMD was measured by Z- scores of both femurs and lumbar spine. Resting metabolic rate (RMR) was measured using indirect calorimetry and strength was determined using a hand grip dynamometer.ResultsAll hEDS/HSD participants reported GI symptoms. There was no difference in body composition between hEDS/HSD and controls. Participants with hEDS/HSD had lower BMD both femoral z scores (p=0.02,0.004) and spine z scores (p= 0.04). There was no difference in caloric intake between groups; yet both groups demonstrated caloric deficits. Additionally, hEDS/HSD consumed less protein and more carbohydrates (p=0.03, p=0.03). There were no differences in grip strength.ConclusionsThis study identified that pre-menopausal women with hEDS/HSD presented with significant GI complications and lower BMD than age matched controls. The GI complications and the reduced protein intake long-term may have a lasting impact on bone health. This study found that the GSRS identified and quantified GI symptoms in persons with hEDS/HSD. Future studies are needed for the longitudinal effects of a caloric/protein deficit in this population and to help guide future preventive and nutritional treatment approaches in individuals with hEDS/HSD.